Transtracheal ventilation using an intravenous canula and ambient air for managing asphyxia - abstract

Some patients may be impossible to intubate due to anatomical or pathological obstruction of the airway, and conventional methods of ventilation cannot be employed. One of us (J.H.) has successfully applied transtracheal ventilation in such an emergency. Under the circumstances it was not possible to measure the adequacy of ventilation by this method using arterial blood gas studies. A laboratory experiment using dogs was therefore devised. Five dogs acting as their own control were alternately ventilated by conventional expired air (mouth to endotracheal tube) (M.E.T.T.) and via a transtracheal cannula and insufflation of room air with a blood pressure cuff inflation bulb. (T.T.V.A.). The result showed an oxygen saturation of more than 80 percent in all cases and no significant difference in pH between the groups. There was a statistically significant differences in PO2 in two dogs (p<0.05) and in PCO2 in three instances )p<0.05). However, the differences in favour of M.E.T.T. did not appear clinically significant, and the quality of T.T.V.A. was certainly sufficient to sustain life for the duration of the experiments (AU)

Emergency tracheostomy

A series of 78 cases of emergency tracheostomy performed at the Kingston Public Hospital from 1944 to date is considered. The overall mortality rate was 50.2 per cent. Of 11 cases done by the ear, nose and throat unit within recent months, two died of causes unrelated to the operation. Possible causes of mortality and morbidity, and various details of operative and postoperative care are discussed. A routine for post operative care as followed in the Department of Otolaryngology of the Kingston Public Hospital is decsribed. It is recommended that all tracheostomies be performed by one specific unit and that the postoperative care be the responsibility of that unit. (AU)