Anesth Pain Med.  2022 Jul;17(3):249-255. 10.17085/apm.22163.

Ventilation through a straw

• Kim HJ
• Kim HJ
• Park WK

• KMID: 2535316
• DOI: http://doi.org/10.17085/apm.22163

Abstract

Transtracheal jet ventilation can be used for resuscitation of partial airway obstruction. A prerequisite for jet ventilation is that at least a minimum airway opening for gas escape must be secured. Therefore, another option should be considered in cases of complete airway obstruction. The following methods or devices has been used under cricothyrotomy using an intravenous cannula: 1) Ambu (bag valve mask) bagging, 2) Ventrain® , 3) Rapid-O2 oxygen insufflation device (Rapid-O2), and 4) jet ventilation using a dual lumen catheter. During Ambu bagging, extraordinarily high insufflation pressure is required to force oxygen through the cannula. When using a 12-G cannula, long and slow positive-pressure ventilations (10–12 breaths/min) are required, which makes it extremely difficult to compress the bag. Therefore, a 10-G or larger is recommended. Ventrain® is an expiratory assist device capable of forcibly expelling insufflated oxygen through a transtracheal cannula. It is recommended to adjust the inspiratory and expiratory times while observing the chest wall movements. Rapid-O2 is a rescue oxygenation device with adequate ventilation of less importance; therefore, the resulting hypercarbia is inevitable. A 14-G cannula is used. Lastly, jet ventilation using a dual-lumen catheter with a 16-G inflow lumen and 10-G outflow lumen was used to obtain both oxygenation and ventilation. However, the addition of the outer diameters of 16-G and 10-G results in an outer diameter of 5.1 mm, which is too large to puncture the cricothyroid membrane. In conclusion, Ventrain® is considered the most ideal device for use among the devices developed to date.

Keyword

Airway management; Airway obstruction; Jet ventilation; Transtracheal ventilation

Figure

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  Fig. 1. Ambu bag and connection of the the syringe. After connecting the 8.0-mm endotracheal tube adapter to the rear side of the 3-ml syringe with the plunger removed, the Ambu bag is connected to the rear side of the 8.0-mm endotracheal tube adapter. Finally, the tip of the syringe is connected to the cannula hub.

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  Fig. 2. Ventrain® and its use. (A) Insufflation. (B) Expiration. (C) Equilibrium. When both apertures are closed (bypass closed and thumb closed) (A), insufflation is achieved, and when the aperture at the top (aperture of the exhaust pipe) is opened while the bottom aperture is closed (bypass closed and thumb open) (B), expiration occurs. Equilibration can be accomplished by opening both holes simultaneously (bypass open and thumb open) (C).

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  Fig. 3. Rapid-O2 oxygen insufflation device (A). (B) Inspiration. (C) Expiration. It consists of a T-piece (T-connecter) with an extension tubing attached to a cannula with a Luer lock connector. (A) The T-piece consists of an oxygen flowmeter connection part and a single large opening that could be closed and opened with a thumb. (B) Thumb occlusion of the T-piece allows oxygen to flow from the flowmeter to the cannula, while releasing the thumb (C) allows for both passively expired gas and flowmeter gas to vent into the atmosphere.

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