459: A SIMPLE DEVICE CONSTRUCTED FROM EASILY ACCESSIBLE COMPONENTS IMPROVES EMERGENCY PERCUTANEOUS TRANSTRACHEAL VENTILATION

Abstract

Percutaneous transtracheal ventilation (PTV), a rescue maneuver for the “cannot intubate - cannot ventilate” scenario, is limited by the risks of high inspiratory airway pressure (PAW) and low minute ventilation (VE). Our goal was to design a device from easily accessible components that obviates the limitations of standard PTV mechanisms by augmenting the exhalation process.

We hypothesized that a novel device using augmented exhalation would result in lower PAW and higher VE than standard-of-care (SOC) devices for PTV.

A VT-1 test lung (Bio-Tek Instruments, Inc., Winooski, VT, USA) simulating total upper airway obstruction was used to measure performance variables across 20 respiratory cycles per device. PTV was performed using a 14-gauge angiocatheter 45 mm long with 700 ml tidal volume. Six apparatus were constructed from materials readily available in the ICU and peri-operative settings. The best performing apparatus was tested with four oxygen sources to obtain optimal performance. This novel device was tested against three SOC devices for PTV.

The novel device was composed of a 3-way stopcock allowing inspiration with wall-mounted oxygen (flowmeter, 18 psi) and augmented exhalation with suction (-150 mmHg). The best SOC device used central oxygen supply (15 psi) and passive exhalation. When tested using normal lung compliance and resistance, peak PAW was significantly lower with the novel device (27 ± 3 cmH2O) as compared to the optimal SOC device (51 ± 20 cmH2O) (p<0.05). VE was significantly higher with the novel device (7056 ± 321 ml/min) as compared to the optimal SOC device (3218 ± 238 ml/min) (p<0.05). Similar differences in performance were found for asthmatic and emphysematous lung models.

We demonstrated a simple, effective device for PTV composed entirely of materials ubiquitously available in the ICU and peri-operative environments. This device provided superior ventilation at lower airway pressure than current SOC devices.