| The Efficacy of Spontaneous and Controlled Ventilation With Various Cricothyrotomy Devices: A Quantitative In Vitro Assessment in a Model Lung. | |
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MedLine Citation:
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PMID: 21399543 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND:: Guidelines for the management of a difficult airway recommend performing a cricothyrotomy in a "can't intubate/can't ventilate" situation. We investigated the tidal volumes delivered by controlled and spontaneous ventilation by seven commercially available cricothyrotomy sets (cuffed: Quicktrach II, Portex Cricothyroidotomy Kit, and Melker cuffed cannula and uncuffed: Airfree, 4.0-mm ID Quicktrach, 6.0-mm inner diameter Melker, and 13-gauge Ravussin cannula) and two improvised devices (14-gauge intravenous cannula and spike and drip chamber device). METHODS:: A LS800 model lung, set at different values for compliance and resistance and modified with different upper airway diameter, was ventilated via the respective cricothyrotomy device mechanically and using a self-inflating bag. With the 13-gauge Ravussin cannula and the 14-gauge intravenous cannula, a Manujet injector was used for jet ventilation. Spontaneous ventilation was simulated with a Michigan 560i lung. RESULTS:: During controlled or manual ventilation, all cuffed cricothyrotomy devices yielded adequate tidal volumes. Uncuffed devices provided tidal volumes ≥300 mL only with an upper airway diameter of ≤3 mm. With a Manujet injector, adequate tidal volumes required an upper airway diameter between 3 mm and 5 mm. A spike and drip chamber device does not provide suitable emergency airway access. Spontaneous ventilation at adequate inspiratory pressure levels required a device inner diameter of at least 4 mm. CONCLUSION:: As expected, cuffed cricothyrotomy devices yield the best results during controlled, manual, and spontaneous ventilation. With uncuffed cricothyrotomy devices, ventilation becomes ineffective when the upper airway obstruction allows for an upper airway diameter >3 mm. |
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Authors:
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Andrea Michalek-Sauberer; Marcus Granegger; Hermann Gilly |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-3-10 |
Journal Detail:
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Title: The Journal of trauma Volume: - ISSN: 1529-8809 ISO Abbreviation: - Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-3-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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From the Department of Special Anaesthesia and Pain Therapy (A.M.-S., H.G.), Medical University of Vienna, Vienna General Hospital; Institut für Biomedizinische Technik (M.G.), Fachhochschule Technikum Wien; and Ludwig Boltzmann Institute for Anaesthesia and Critical Care (M.G., H.G.), Vienna, Austria. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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