Percutaneous needle cricothyroidotomy with repetitive airway obstruction

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• 作者：Mark Hauswald ; Gracie Ong ; Ernest Yeoh
• 刊名：The American Journal of Emergency Medicine
• 出版年：1995
• 出版时间：November 1995
• 年：1995
• 卷：13
• 期：6
• 页码：623-625
• 全文大小：360 K

文摘

To develop a technique for needle cricothyrotomy that mimics the normal respiratory cycle (using repetitive obstruction of the upper airway and relatively low flow oxygen through small catheters), a controlled trial in three anesthestized dogs was performed. Oxygen from a standard bottle and pressure reducer was delivered through the cricothyroid membrane at 0.36 L/kg/min, which is metabolically equivalent to 0.2 L/kg/min in an adult human. The upper airway was obstructed until the chest rose and then was unobstructed to allow exhalation. The animals were ventilated for 5 minutes to allow equilibration. Arterial Pco<sub>2sub> was measured after 2-minute periods of apnea and 3 minutes of ventilation, each repeated four times. The procedure was repeated in three other dogs at a flow of 0.18 L/kg/min to simulate a 50 % air leak. Cricothyroid ventilation at 0.36 L/kg/min lowered the Pco<sub>2sub> from 65 mm Hg to 43 mm Hg, F = 258, P = .004. All Pco<sub>2sub>s after 25 minutes were in the normal range. Ventilation at 0.18 L/kg/min stabilized the Pco<sub>2sub> at approximately 1.5 times normal (67 mm Hg versus 79 mm Hg for the preceding apnea, F = 77, P = .013). Flow rates achievable with 18- to 20-gauge catheters and standard oxygen sources are adequate for cricothyroid ventilation when the airway is repetitively obstructed to allow a normal respiratory cycle.