Rescue ventilation through a small-bore transtracheal cannula in severe hypoxic pigs using expiratory ventilation assistance

Abstract

Background: Suction-generated expiratory ventilation assistance (EVA) has been proposed as a way to facilitate bidirectional ventilation through a small-bore transtracheal cannula (TC). In this study, we investigated the efficiency of ventilation with EVA for restoring oxygenation and ventilation in a pig model of acute hypoxia.

Methods: Six pigs (61-76 kg) were anesthetized and ventilated (intermittent positive pressure ventilation) via a cuffed endotracheal tube (ETT). Monitoring lines were placed, and a 75-mm long, 2-mm inner diameter TC was inserted. After the baseline recordings, the ventilator was disconnected. After 2 minutes of apnea, reoxygenation with EVA was initiated through the TC and continued for 15 minutes with the ETT occluded. In the second part of the study, the experiment was repeated with the ETT either partially obstructed or left open. Airway pressures and hemodynamic data were recorded, and arterial blood gases were measured. Descriptive statistical analysis was performed.

Results: With a completely or partially obstructed upper airway, ventilation with EVA restored oxygenation to baseline levels in all animals within 20 seconds. In a completely obstructed airway, PaCO2 remained stable for 15 minutes. At lesser degrees of airway obstruction, the time to reoxygenation was delayed. Efficacy probably was limited when the airway was completely unobstructed, with 2 of 6 animals having a PaO2 <85 mm Hg even after 15 minutes of ventilation with EVA and a mean PaCO2 increased up to 90 mm Hg.

Conclusions: In severe hypoxic pigs, ventilation with EVA restored oxygenation quickly in case of a completely or partially obstructed upper airway. Reoxygenation and ventilation were less efficient when the upper airway was completely unobstructed.

Figure 1.

The two functional modes of the DE 5. A, Device activated, insufflation: oxygen flows from the inlet (1) to the connecting tubing (3). The outlet (2) is occluded by finger. B, Device activated, expiratory ventilation assistance: oxygen flows from the inlet (1) to the outlet (2) entraining gas from the connecting tubing (3) by the Bernoulli effect.

Figure 2.

A, Course of Pao₂ at different upper airway patency before (−120 seconds) and after 2 minutes of apnea (0) and subsequent ventilation with expiratory ventilation assistance (EVA) during 15 minutes (part 2 of the study). The endotracheal tube (ETT) either fully open or obstructed with a 3-mm hole or a 50-mm long, 2-mm stenosis. Data presented as mean and range. B, Course of arterial oxygen saturation (Sao₂) at different upper airway patency before (−120 seconds) and after 2 minutes of apnea (0) and subsequent ventilation with EVA during 15 minutes (part 2 of the study). The ETT either fully open or obstructed with a 3-mm hole or a 50-mm long, 2-mm stenosis. Data presented as mean and range. C, Course of Paco₂ at different upper airway patency before (−120 seconds) and after 2 minutes of apnea (0) and subsequent ventilation with EVA during 15 minutes (part 2 of the study). The ETT either fully open or obstructed with a 3-mm hole or a 50-mm long, 2-mm stenosis. Data presented as mean and range.