1998 OPEN FORUM Abstracts
TTOT: Evolution or Revolution?
John R. Goodman BS RRT
Transtracheal oxygen therapy was first developed by Heimlich in the early 1980's, and subsequently a number of transtracheal catheters were developed and introduced. By far the most common transtracheal catheter in use both in the United States, and around the world today, is the SCOOP transtracheal oxygen catheter. For transtracheal oxygen to be effective, it is best to consider this therapy more than just a procedure, but rather a full program of care. The program works best when a team approach is utilized with a physician as team leader, and the day to day aspects of the program, administered and clinically monitored by respiratory therapists. Those hospitals that have Pulmonary Rehabilitation programs are able to offer the best results possible to their patients, as the combination of transtracheal oxygen and pulmonary rehabilitation, allow COPD patients to have additional benefits, especially in the areas of reduced work of breathing, increased exercise capacity, and reduced dyspnea. While the benefits of low flow transtracheal oxygen therapy have been well documented over the past 16 years (over 130 references in the medical literature), research over the past 5-10 years has identified three exciting new areas of advanced application. When flow rates in the range of 6-15 liters per minute (TTHF) are introduced into the trachea through a transtracheal catheter, a number of other clinical effects have been observed and studied. These are in the areas of augmented nocturnal ventilation (NPPV), reduction or elimination of sleep apneic episodes with their associated nocturnal desaturations, and as an aid to weaning the difficult to wean patient. Much like an endotracheal tube, the tip of a transtracheal catheter sits 2-4 centimeters above the carina, and is therefore in excellent position to deliver additional volumes of fresh (oxygen laden) gas to the lungs, while enhancing carbon dioxide removal as a consequence of bulk gas delivery, and turbulent flow patterns above the carina. While transtracheal oxygen is invasive to the point that a transtracheal catheter must be placed in the trachea, compliance with TTHF is far better than compliance with either CPAP or BiPAP therapy requiring a tight fitting mask and straps.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.