Percutaneous transtracheal jet ventilation - A safe, quick, and temporary way to provide oxygenation and ventilation when conventional methods are unsuccessful

Introduction: Percutaneous transtracheal jet ventilation (PTJV) with a larg e-bore angiocath that is inserted through the cricothyroid membrane can pro vide immediate oxygenation from a high-pressure (50 Ib per square inch) oxy gen wall outlet, as well as ventilation by means of manual triggering. The objective of this retrospective study is to highlight the potential benefit of PTJV as a temporary lifesaving procedure Juring difficult situations wh en oral endotracheal intubation is unsuccessful and bag-valve-mask ventilat ion is ineffective for oxygenation during acute respiratory failure. Methods: The medical records of 29 consecutive patients who required emerge nt PTJV within the past 4 years were reviewed, PTJV was required because th e pulse O-2 saturation could not be maintained at > 90% with bag-mask-valve ventilation and because the airway could not be secured quickly with direc t laryngoscopy. Results: The cricothyroid membrane was cannulated successfully in 23 patien ts. In these patients, pulse O-2 saturation was raised to > 90% and was mai ntained with PTJV until the airway was secured. All but 3 of the 23 patient s were subsequently intubated orally. In one patient, PTJV maintained adequ ate gas exchange until an emergent tracheostomy was performed. In two patie nts, airway exchange catheters were inserted into the trachea due to a smal l glottic aperture. The endotracheal tube was slid over the catheter, In 6 of the 29 patients, there was difficulty inserting a catheter through the c ricothyroid membrane or there was inability to insufflate the oxygen with a jet ventilator. There were no immediate fatalities from the use of PTJV. Conclusion: Based on the subsequent insertion of an endotracheal tube into the trachea, there were two important benefits in the patients who underwen t PTJV successfully. First, PTJV provided effective oxygenation, while allo wing adequate time for upper airway visualization and possible suctioning o f oropharyngeal secretions. Second, tracheal intubation was subsequently ea sier, possibly because the high tracheal pressure from the gas insufflation opened the collapsed glottis, making visualization of the glottic aperture better, PTJV is safe and quick in providing immediate oxygenation, and the refore should be considered as an alternative to insistent, multiple intuba tion attempts, when neither bag-mask-valve ventilation nor endotracheal int ubation is feasible in providing adequate gas exchange.