Continuous flow apnoeic ventilation via intratracheal oxygen insufflation

Background: In patients with disturbed gas-exchange (e.g. COPD) intratrache al oxygen insufflation (ITO2) improves oxygenation and reduces the minute v entilation. We use a bronchoscopic technique of intratracheal catheter plac ement in unintubated patients. In a patient with a pink-puffer emphysema af ter endoscopical insertion of the catheter ITO2 induced a "continuous flow apnoeic ventilation" (CFAV). Case Report: A patient (female, 58 years) with a pink-puffer emphysema was admitted to the ICU with acute on chronic respiratory failure due to acute laryngitis. Because of laryngitis associated upper airway obstruction a non -invasive mechanical ventilation could not be performed. The ensuing high f low ITO2 (10 l/min) induced a CFAV characterized by no chest wall movement and adequate ventilation as reflected by stable, elevated paCO(2) (between 118 and 125 mm Hg), which could be maintained for 4 hours. After an ensuing short-term invasive mechanical ventilation and the administration of high dose glucocorticoids the patient was successfully extubated and the clinica l status improved continuously. Conclusion: In a patient with an acute on chronic respiratory failure due t o end-stage emphysema ITO2 induced CFAV and stabilized the clinical status. Especially in patients with end-stage emphysema, who are likely to be diff icult to be weaned from the respirator ITO2 may be feasable technique in or der to bridge an emergency situation.