Long-term clinical experience with transtracheal oxygen catheters

Transtracheal oxygen catheters

Over the past 20 years a variety of transtracheal catheters have been developed for long-term oxygen therapy. A modified Seldinger technique has been the standard in the past, but a more recent procedure for surgical creation of the tracheocutaneous tract presents a number of potential advantages. TTO should be administered as a program of care, and recent advances with a streamlined and shortened program have simplified and improved the delivery of a technology that has a number of potential benefits and established safety. TTO may further increase the oxygen conservation efficiency of demand oxygen controller devices, and studies have shown TTO to be a potential alternative to nasal oxygen, continuous positive airway pressure, and tracheotomy for severe obstructive sleep apnea. Very high flows (> 10 L/minute) of a humidified air/oxygen blend, termed transtracheal augmented ventilation, extend the physiologic benefits of TTO and have promise in both the outpatient nocturnal ventilatory support of patients with severe respiratory disease and in liberation of patients from prolonged mechanical ventilation.

Effect of Tracheal Gas Insufflation During Weaning From Prolonged Mechanical Ventilation: A Preliminary Study

• Background Tracheal gas insufflation reduces inspired tidal volume and minute ventilation in spontaneously breathing patients and may facilitate weaning from mechanical ventilation.

• Objective To determine if tracheal gas insufflation can reduce ventilatory demand during weaning trials in patients who require prolonged mechanical ventilation.

• Methods A reduction in ventilatory demand was defined as a relative decrease in tidal volume, minute ventilation, and mean inspiratory flow during trials with tracheal gas insufflation compared with the values during trials without this therapy. A total of 14 subjects underwent T-piece trials with and without insufflation (flow rate 6 L/min) on 2 consecutive days; the order of insufflation was randomized. Tidal volume, minute ventilation, and mean inspiratory flow were measured at baseline (without insufflation) and 2 hours later.

• Results Differences in ventilatory demand were not significant when comparisons were made for condition (tracheal gas insufflation vs no flow) or time (baseline vs 2 hours) for the total group (P = .48). Subjects were classified post hoc as responders (n = 9) or nonresponders (n = 5). Comparisons between responders and nonresponders indicated a significant (P = .02) 3-way multivariate interaction for group (responder vs nonresponder), condition (tracheal gas insufflation vs no flow), and time (baseline vs 2 hours) for ventilatory demand variables.

• Conclusion Tracheal gas insufflation can reduce ventilatory demand during weaning trials in some patients who require mechanical ventilation.

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.