The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

Jet Ventilation during Rigid Bronchoscopy in the Face of Tracheal Stricture

James S. Wood RRT, Michael A. Gentile RRT FAARC, Momen Wahidi MD Duke University Medical Center Durham , NC

Background: Evidence of inadequate ventilation was noticed during rigid bronchoscopy when tracheal stenosis or stricture was present. The purpose of this study is to quantify the amount of stricture that will cause ventilation impairment and necessitate an alternate means of ventilation.

Methods: We performed a bench evaluation using a test lung (Michigan Instruments, Grand Rapids, MI), NICO monitor (Respironics, Wallingford, CT), sizes 3.0mm-6.5mm endotracheal tubes, large Bryan-Dumond Series II tracheoscope with jet ventilation port (Bryan Corporation, Woburn, MA.), and Bear 150 jet ventilator (VIASYS Healthcare, Palm Springs, CA). The tracheoscope was inserted into a 9mm tube and the NICO monitor was attached to the test lung. The jet ventilator was set at an inspiratory pressure (IP) of 15psi, rate 50 bpm, and I time 25%. The test lung compliance was set 0.10 L/cmH2O. Data was first collected without stricture to establish a baseline for Vt and PIP. Each endotracheal tube was placed distal to the 9mm tube and proximal to the NICO. After the initial baseline, the IP was increased to achieve the baseline (Vt) and data were obtained.

Results:

  Vt (ml) Ve (lpm) PIP (cmH2O) Cdyn (ml/ cmH2O) PSI (Δ) PIP (cmH2O)
Base 407 21.4 9 73 na na
6.5mm 300 15.9 16 58 24 25
6.0mm 266 14.0 17 55 27 32
5.5mm 253 13.0 18 43 29 36
5.0mm 239 12.6 20 40 32 45
4.5mm 188 9.7 23 30 *** ***
4.0mm 162 8.0 26 24 *** ***
3.5mm 127 6.4 29 20 *** ***
3.0mm 98 4.7 24 16 *** ***

Conclusions: If a patient has a tracheal stricture that decreases the lumen size to 4.5mm or less an alternative means of ventilation other than jet ventilation should strongly be considered to ensure adequate ventilation.

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