Ventrain: From Theory To Practice. Bridging Until Re-tracheostomy

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Abstract

Imminent upper airway obstruction due to life-threatening tracheal stenosis of any cause is challenging. A 77-year-old woman, with a history of temporal tracheostomy for prolonged mechanical ventilation, presented with life-threatening tracheal stenosis to the emergency department. After failed intubation with a 5.0 mm internal diameter endotracheal tube, the patient was ventilated via a tube exchanger using Ventrain. Ventrain is a manual ventilation device that, in addition to oxygen supply during inspiration, initiates expiration by actively removing gas from the lungs by suction. Despite the nearly obstructed airway the patient was adequately ventilated with 'permissive' hypercarbia of 50 mm Hg and Saturation of peripheral Oxygen (SpO2) 95%-98% until surgical re-tracheostomy was performed. The haemodynamic stability of the patient indicated that the active expiration prevented intrapulmonary pressure build-up by air trapping and subsequent barotrauma and/or haemodynamic deterioration, which may well be observed during traditional jet ventilation especially in case of a completely obstructed airway.

Keywords: Anaesthesia; Emergency Medicine.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1

Figure 1

Working mechanism of Ventrain (expiratory…

Figure 1

Working mechanism of Ventrain (expiratory ventilation assistance technology). (A) Equilibration mode. The gas…

Figure 1 Working mechanism of Ventrain (expiratory ventilation assistance technology). (A) Equilibration mode. The gas flows via the inlet (1) through a very narrow nozzle (2) towards the exhaust pipe (3). No flow from or to the patient. (B) Closing both the exhaust pipe (3) and safety bypass (5) forces the oxygen to flow via the inlet (1) through the narrow nozzle (2) towards the patient via port (4): inspiration. (C) Expiration: The gas flows via the inlet (1) through a very narrow nozzle (2) and exhaust pipe (3) to the outside. The flow entrains gas from port (4), which is connected to a catheter: active expiration. The bypass (5) functions as an on/off switch. When opened, there is no significant positive or negative pressure at the catheter tip, resulting in equilibration/safety mode.
Figure 2

Figure 2

CT of the thorax shows…

Figure 2

CT of the thorax shows the sternoclavicular joint with tracheal stenosis.

Figure 2 CT of the thorax shows the sternoclavicular joint with tracheal stenosis.
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References

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