Transtracheal oxygen delivery

Transtracheal oxygen catheters in a pediatric population

This is the first report to evaluate transtracheal oxygen catheter (TTOC) use in a pediatric patient series. Seven pediatric patients (4 boys and 3 girls) received TTOCs in 2 tertiary care medical centers. The medical indications included bronchopulmonary dysplasia in 4 patients and tracheomalacia in the other 3. The average age at the time of placement was 22 months (range, 2 weeks to 37 months). Catheter placement for 4 patients was through an open tracheotomy stoma. In 3, placement was through a percutaneous technique. The follow-up ranged from 2 weeks to 5 years. There were no long-term complications. Transient needs for supplemental oxygen were all met by the TTOC system. In 4 patients, the catheter has been removed because of resolution of the supplemental oxygen requirements. Minor complications included skin site infection and mucus plugging. In 1 patient, accidental dislodging of the catheter led to its replacement in the operating room. In 1 percutaneous placement, a pneumothorax occurred and resolved without any persistent morbidity. We conclude that transtracheal oxygen delivery can be a reasonable alternative to a nasal cannula or formal tracheotomy in selected pediatric patients in whom long-term oxygen delivery, but not an alternate airway, is required. In order to avoid complications, meticulous technique must be adhered to in using the percutaneous approach for placement.

Long-term clinical experience with transtracheal oxygen catheters

OBJECTIVE

To evaluate and discuss the use of transtracheal oxygen catheters for the treatment of chronic hypoxemia and to discuss the complications associated with the placement and care of these devices.

DESIGN

We conducted a retrospective study at a tertiary medical center and reviewed the pertinent literature.

MATERIAL AND METHODS

The medical records of 56 patients who received a transtracheal oxygen catheter between January 1987 and June 1992 at our institution were reviewed for demographic data, diagnosis leading to catheter placement, complications related to catheter use, reason for catheter removal, and duration of use. Follow-up results were established by documentation in the medical records or telephone interview.

RESULTS

During the study period, 39 men and 17 women received a transtracheal catheter. More than half the patients (52%) had chronic obstructive pulmonary disease. The duration of use of the catheter ranged from 2 days to more than 6 years, and the most frequent cause for removal of the catheter was death. Of the 56 patients, 42 died with the catheter in place, 24 within the first year after placement. Complications ranged from mucous plugging (38 % of patients) to pneumothorax (4%), and no patient died of a catheter-related complication. Overall, 55% of patients had their catheter for less than 1 year after placement.

CONCLUSION

In patients with transtracheal oxygen catheters, problems related to mucous plugging are common, but severe complications such as pneumothorax and pneumomediastinum are uncommon. Although selection factors that would identify ideal candidates for transtracheal oxygen therapy have not been established, such a catheter is best placed in highly motivated patients who can physically manage the daily care of this device.

A nearly fatal tracheal obstruction resulting from a transtracheal oxygen catheter

In a patient with a transtracheal oxygen catheter (ITO2C), a nearly fatal complication occurred due to the formation of a mucous plug on the tip, which almost totally obstructed the tracheal lumen. To our knowledge, this complication has not been reported before with the use of this type of transtracheal oxygen catheter.