Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-18T23:18:20.812Z Has data issue: false hasContentIssue false

Chapter 18 - Expiratory Ventilation Assistance and Ventilation through Narrow Tubes

from Section 1 - Airway Management: Background and Techniques

Published online by Cambridge University Press:  03 October 2020

By
Michiel W.P. de Wolf  and
Michael Seltz Kristensen
Edited by
Tim Cook  and
Michael Seltz Kristensen
Tim Cook
Affiliation:
Royal United Hospital, Bath, UK
Michael Seltz Kristensen
Affiliation:
Rigshospitalet, Copenhagen University Hospital, Denmark
Get access

Summary

A major challenge of airway management is safe care of the patient with a narrowed airway. Small tracheal tubes offer one solution but pose a problem with ventilation. While inspiration may be achieved by use of a high-pressure source to overcome airway resistance, two problems exist: first, the high-pressure source demands technical excellence and exposes the patient to a high risk of barotrauma; second, conventional (passive) exhalation through a narrow tube is slow and cannot achieve a normal minute ventilation with a tracheal tube of less than 4.5 mm diameter. Recently technical developments have led to the ability to assist expiration and make it, like inspiration, an active process. This technology is used in the Ventrain manual ventilator, the 2.4 mm wide Tritube tracheal tube and the Evone automatic ventilator. These new devices and the applied technology enable solutions for safe management of the narrowed upper airway.

Keywords

Bernoullidifficult airwayexpiratory assistintubationventilation
Type
Chapter
Information
Core Topics in Airway Management , pp. 161 - 165
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further Reading

Berry, M, Tzeng, Y, Marsland, C. (2014). Percutaneous transtracheal ventilation in an obstructed airway model in post-apnoeic sheep. British Journal of Anaesthesia, 113, 1039–1045.Google Scholar
Cook, TM, Nolan, JP, Cranshaw, J, Magee, P. (2007). Needle cricothyroidotomy. Anaesthesia, 62, 289–290.CrossRefGoogle ScholarPubMed
Hamaekers, AE, Borg, PA, Enk, D. (2012). Ventrain: an ejector ventilator for emergency use. British Journal of Anaesthesia, 108, 1017–1021.Google Scholar
Kristensen, MS, de Wolf, MWP, Rasmussen, LS. (2017). Ventilation via the 2.4 mm internal diameter Tritube® with cuff – new possibilities in airway management. Acta Anaesthesiologica Scandinavica, 61, 580–589.Google Scholar
Paxian, M, Preussler, NP, Reinz, T, Schlueter, A, Gottschall, R. (2015). Transtracheal ventilation with a novel ejector-based device (Ventrain) in open, partly obstructed, or totally closed upper airways in pigs. British Journal of Anaesthesia, 115, 308–316.Google Scholar
Willemsen, MG, Noppens, R, Mulder, AL, Enk, D. (2014). Ventilation with the Ventrain through a small lumen catheter in the failed paediatric airway: two case reports. British Journal of Anaesthesia, 112, 946–947.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×