Successful Transtracheal Lung Ventilation Using a Manual Respiration Valve: An In Vitro and In Vivo Study
Successful Transtracheal Lung Ventilation Using a Manual Respiration Valve: An In Vitro and In Vivo Study
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使用手动呼吸阀成功进行经气管肺通气：体外和体内研究
DOI：
10.1097/aln.0b013e31817f3de6
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发表时间：
2008
期刊：
影响因子：
8.8
通讯作者：
D. Pavlovic
中科院分区：
文献类型：
--
作者：
K. Meissner;T. Iber;J. Roesner;C. Mutz;H.E. Wagner;C. Layher;U. Bartels;M. Gründling;T. Usichenko;M. Wendt;C. Lehmann;D. Pavlovic
背景：在喉狭窄或“不能插管，不能通气”的情况下，可以尝试通过细气管插管进行肺通气。如果肺部仅通过细的经气管插管自发排空，则可能无法实现充分的通气，这对气流施加了高阻力，导致危险的过度充气。因此，作者描述了手动呼吸阀的使用，该手动呼吸阀用作双向泵，在紧急经气管肺通气的情况下不仅提供充气，还提供主动放气。方法：在体外使用机械肺结合两种不同的插管尺寸和各种气体流量来测试这种阀的有效性。然后在5头猪中使用经气管16号插管对瓣膜进行测试，其中吸气/呼气时间和气流的三种不同组合以及阻塞的上气道。结果：在机械肺中，与自发肺排空相比，瓣膜允许更高的分钟通气量。在体内，动脉氧分压和二氧化碳分压最初升高，然后在1 h内保持稳定（动脉氧分压，470.8 ± 86.8;动脉二氧化碳分压，63.0 ± 7.2 mmHg）。在气管中测量的吸气压力保持在10 cm H2O以下，基本上不影响中心静脉压和肺动脉压。平均动脉压和心输出量不受通气操作的影响。结论：本研究在成年猪的体外和体内证明，如果与双向手动呼吸阀结合使用，通过16号插管进行经气管通气可确保长时间的肺通气。
Background:Lung ventilation through a thin transtracheal cannula may be attempted in patients with laryngeal stenosis or “cannot intubate, cannot ventilate” situations. It may be impossible to achieve sufficient ventilation if the lungs are spontaneously emptying only through the thin transtracheal cannula, which imposes high resistance to airflow, resulting in dangerous hyperinflation. Therefore, the authors describe the use of a manual respiration valve that serves as a bidirectional pump providing not only inflation but also active deflation of the lungs in case of emergency transtracheal lung ventilation. Methods:The effectiveness of such a valve was tested in vitro using mechanical lungs in combination with two different cannula sizes and various gas flows. The valve was then tested in five pigs using a transtracheal 16-gauge cannula with three different combinations of inspiratory/expiratory times and gas flows and an occluded upper airway. Results:In the mechanical lungs, the valve permitted higher minute volumes compared with spontaneous lung emptying. In vivo, the arterial oxygen and carbon dioxide partial pressures increased initially and then remained stable over 1 h (arterial oxygen tension, 470.8 ± 86.8; arterial carbon dioxide tension, 63.0 ± 7.2 mmHg). The inspiratory pressures measured in the trachea remained below 10 cm H2O and did not substantially influence central venous and pulmonary artery pressures. Mean arterial pressure and cardiac output were unaffected by the ventilation maneuvers. Conclusions:This study demonstrated in vitro and in vivo in adult pigs that satisfactory lung ventilation can be assured with transtracheal ventilation through a 16-gauge cannula for a prolonged period of time if combined with a bidirectional manual respiration valve.