Ventilation strategies for front of neck airway rescue

• Verfasst von: Laviola, Marianna [VerfasserIn]
• Verfasst von: Niklas, Christian [VerfasserIn]
• Verfasst von: Das, Anup [VerfasserIn]
• Verfasst von: Bates, Declan G. [VerfasserIn]
• Verfasst von: Hardman, Jonathan G. [VerfasserIn]
• Titel: Ventilation strategies for front of neck airway rescue
• Titelzusatz: an in silico study
• Verf.angabe: Marianna Laviola, Christian Niklas, Anup Das, Declan G. Bates and Jonathan G. Hardman
• E-Jahr: 2021
• Jahr: 3 March 2021
• Umfang: 11 S.
• Fussnoten: Gesehen am 01.03.2022
• Titel Quelle: Enthalten in: British journal of anaesthesia
• Ort Quelle: [Amsterdam] : Elsevier, 1923
• Jahr Quelle: 2021
• Band/Heft Quelle: 126(2021), 6 vom: Juni, Seite 1226-1236
• ISSN Quelle: 1471-6771
• DOI: doi:10.1016/j.bja.2021.01.030
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: airway management
• Sach-SW: airway obstruction
• Sach-SW: apnoea
• Sach-SW: cannot intubate
• Sach-SW: cannot oxygenate
• Sach-SW: front of neck airway
• Sach-SW: oxygenation simulation
• K10plus-PPN: 1794106383

Abstract

Background - During induction of general anaesthesia a ‘cannot intubate, cannot oxygenate’ (CICO) situation can arise, leading to severe hypoxaemia. Evidence is scarce to guide ventilation strategies for small-bore emergency front of neck airways that ensure effective oxygenation without risking lung damage and cardiovascular depression. - Methods - Fifty virtual subjects were configured using a high-fidelity computational model of the cardiovascular and pulmonary systems. Each subject breathed 100% oxygen for 3 min and then became apnoeic, with an obstructed upper airway. When arterial haemoglobin oxygen saturation reached 40%, front of neck airway access was simulated with various configurations. We examined the effect of several ventilation strategies on re-oxygenation, pulmonary pressures, cardiovascular function, and oxygen delivery. - Results - Re-oxygenation was achieved in all ventilation strategies. Smaller airway configurations led to dynamic hyperinflation for a wide range of ventilation strategies. This effect was absent in airways with larger internal diameter (≥3 mm). Intrapulmonary pressures increased quickly to supra-physiological values with the smallest airways, resulting in pronounced cardio-circulatory depression (cardiac output <3 L min−1 and mean arterial pressure <60 mm Hg), impeding oxygen delivery (<600 ml min−1). Limiting tidal volume (≤200 ml) and ventilatory frequency (≤8 bpm) for smaller diameter cannulas reduced dynamic hyperinflation and gas trapping, preventing cardiovascular depression. - Conclusions - Dynamic hyperinflation can be demonstrated for a wide range of front of neck airway cannulae when the upper airway is obstructed. When using small-bore cannulae in a CICO situation, ventilation strategies should be chosen that prevent gas trapping to prevent severe adverse events including cardio-circulatory depression.