TY - JOUR
T1 - Brief review
T2 - Supplementing oxygen through an airway exchange catheter: Efficacy, complications, and recommendations
AU - Duggan, Laura V.
AU - Law, J. Adam
AU - Murphy, Michael F.
PY - 2011/6
Y1 - 2011/6
N2 - Purpose: An airway exchange catheter (AEC) may be employed as a conduit for endotracheal tube placement and for oxygen insufflation or jet ventilation via its lumen. The recent barotrauma-related death of a young healthy patient receiving oxygen insufflated through an AEC prompted the Chief Coroner of Ontario to seek guidelines regarding their use. A literature search was undertaken using a number of search strategies to investigate both the efficacy and complications associated with supplying oxygen through an AEC. Principal findings: No studies were found comparing either oxygen insufflation or jet-ventilation through an AEC to any standard forms of oxygen therapy. The only case series found using AEC jet ventilation reported that 11% of patients sustained pulmonary barotrauma. Thirteen case reports documented jet ventilation as being associated with pneumothorax, pneumomediastinum, pneumoperitoneum, cardiovascular collapse, and death. In three case series (totalling 76 adults and 20 children) using only oxygen insufflation, no complications were reported. Conclusions: Jet ventilation through an AEC may be associated with a significant risk of barotrauma. Oxygen insufflation appears to be associated with a lower risk, but it is not risk-free. The authors caution against the use of an AEC to administer oxygen failing the proven benefit of its use over the use of standard oxygen therapies. Should a patient decompensate with an AEC in situ, tracheal re-intubation is the key management strategy. Supplemental oxygen can be provided using standard techniques prior to tracheal intubation or between attempts. Under emergency circumstances, oxygen insufflation or manual ventilation through an AEC may be considered provided vigilance for barotrauma is maintained and re-intubation is not delayed.
AB - Purpose: An airway exchange catheter (AEC) may be employed as a conduit for endotracheal tube placement and for oxygen insufflation or jet ventilation via its lumen. The recent barotrauma-related death of a young healthy patient receiving oxygen insufflated through an AEC prompted the Chief Coroner of Ontario to seek guidelines regarding their use. A literature search was undertaken using a number of search strategies to investigate both the efficacy and complications associated with supplying oxygen through an AEC. Principal findings: No studies were found comparing either oxygen insufflation or jet-ventilation through an AEC to any standard forms of oxygen therapy. The only case series found using AEC jet ventilation reported that 11% of patients sustained pulmonary barotrauma. Thirteen case reports documented jet ventilation as being associated with pneumothorax, pneumomediastinum, pneumoperitoneum, cardiovascular collapse, and death. In three case series (totalling 76 adults and 20 children) using only oxygen insufflation, no complications were reported. Conclusions: Jet ventilation through an AEC may be associated with a significant risk of barotrauma. Oxygen insufflation appears to be associated with a lower risk, but it is not risk-free. The authors caution against the use of an AEC to administer oxygen failing the proven benefit of its use over the use of standard oxygen therapies. Should a patient decompensate with an AEC in situ, tracheal re-intubation is the key management strategy. Supplemental oxygen can be provided using standard techniques prior to tracheal intubation or between attempts. Under emergency circumstances, oxygen insufflation or manual ventilation through an AEC may be considered provided vigilance for barotrauma is maintained and re-intubation is not delayed.
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U2 - 10.1007/s12630-011-9488-4
DO - 10.1007/s12630-011-9488-4
M3 - Review article
C2 - 21465321
AN - SCOPUS:79959934412
SN - 0832-610X
VL - 58
SP - 560
EP - 568
JO - Canadian Journal of Anaesthesia
JF - Canadian Journal of Anaesthesia
IS - 6
ER -