Elsevier

Clinics in Chest Medicine

Volume 24, Issue 3, September 2003, Pages 489-510
Clinics in Chest Medicine

Transtracheal oxygen catheters

https://doi.org/10.1016/S0272-5231(03)00051-0Get rights and content

Section snippets

Overview of the SCOOP

The SCOOP for developing the TTO catheter tract was initially constructed around a modified Seldinger technique (MST). The MST program has been extensively described elsewhere [17]. An alternative surgical method for tract creation was introduced [18] in 1996. Lipkin's surgical approach [18] presents some potential advantages over the MST, which include a reduction in potential complications and both streamlined education and shortened program duration. To date, there are supporters of both

Complications of a program using the MST for tract creation

The potential complications resulting from administration of the transtracheal oxygen program by the MST are shown in Table 1. The table presents the initial large experience in United States [16] and compares those results with a more recent study from the Netherlands [19]. The investigation of Kampelmacher and colleagues [19] adds additional value because the Netherlands experience with their initial 10 patients is contrasted with results obtained from their subsequent 65 patients.

Potential benefits of transtracheal oxygen therapy

The potential benefits of transtracheal oxygen therapy compared with nasal oxygen delivery are shown in Box 1. A number of physiologic benefits have been described in the literature. We noted a marked reduction in erythrocytosis in the treatment of hypoxemia that was refractory to nasal oxygen therapy [15]. Significant reductions in hematocrit were also seen in patients thought to be adequately treated with nasal cannula therapy [16]. Domingo and associates reported reduced pulmonary vascular

Highlights of the SCOOP with the MST for tract creation

This section is a discussion of the overall program, but is not intended as a comprehensive educational manual for patient care. The entire SCOOP using MST has been more fully described elsewhere [17]. Comprehensive video, electronic, and printed educational materials are available through the manufacturer (Transtracheal Systems Inc, Denver CO)

The Lipkin surgical procedure and modified SCOOP

Alan Lipkin, an otolaryngoligist, developed a surgical procedure for revision of previous MST tracts that resulted in recurrent problems such as chondritis, lost tracts, and keloids. Our further investigation suggested that the surgical approach has a number of advantages over the MST as a primary method of tract creation [18]. We have modified the SCOOP to be used in conjunction with the Lipkin surgical procedure for TTO tract creation [18]. The program is an alternative to the SCOOP for the

Combination of TTO and demand oxygen delivery systems

TTO has been classified as an oxygen conserving device. Though TTO certainly provides other benefits, flow requirements are significantly reduced during rest and exercise [16]. Because demand oxygen delivery systems (DODS) have also been shown to conserve oxygen, we conducted in initial evaluation to see if the two technologies could be combined [47]. Results showed that oxygen saturations were adequate and that the devices reliably triggered via the transtracheal catheter. In a collaborative

Transtracheal augmented ventilation (TTAV)

Our early anecdotal experience with refractory hypoxemia [15] showed that patients requiring transtracheal flow rates of 4 to 6 L/minute appeared to have less labored breathing compared with periods when the same patients were receiving nasal oxygen at equal or greater flow rates. As noted earlier, TTO studies have demonstrated reductions in inspired minute ventilation [39], physiologic dead space [40], [41], oxygen cost of breathing, and the respiratory duty cycle [42]. Reductions in each of

TTAV for nocturnal support in the home

We then evaluated the potential safety and efficacy of TTAV for the nocturnal home management of a larger number of hypoxemic patients with chronic severe respiratory disease [52]. The first portion of the study evaluated patients before and after a 3-month intervention with nocturnal (Noc) administration of TTAV at 10 L/minute. Resting physiologic studies were conducted on standard low flow transtracheal oxygen (LFTTO), TTAV, and breathing oxygen enriched gas without transtracheal flow via a

TTAV for weaning from prolonged mechanical ventilation

We speculated that the physiologic benefits of TTAV with respect to reductions in inspired minute ventilation, respiratory duty cycle, and oxygen cost of breathing might facilitate the weaning process [53] in patients requiring prolonged mechanical ventilation. In the setting of long-term acute care, we assessed medically stable patients who consistently failed to wean from mechanical ventilation in spite of tracheostomy and weaning efforts using a variety of ventilatory modes. Before

Treatment of sleep apnea

In 1985 we encountered a patient with severe hypoxemia, obesity-hypoventilation syndrome, and associated severe obstructive sleep apnea [55]. The patient did not receive benefit from nasal continuous positive airway pressure (CPAP) and refused tracheotomy. He was placed on TTO for long-term oxygen therapy and sleep polysomnography was done to evaluate his response to nocturnal TTO. Results on 3 L/minute TTO showed that his apneas and hypopneas resolved and oxygen saturation was adequate. Video

Summary

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

Acknowledgements

The author thanks Stephanie Diehl, RRT for her technical assistance and John Goodman, RRT for his photography assistance. Dr. Christopher has licensed transtracheal technology patents for commercial use.

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