King H K
Dept. of Anesthesiology, Charlés R. Drew University of Medicine and Science, Los Angeles, California.
Ma Zui Xue Za Zhi. 1992 Dec;30(4):243-9.
Every anesthesia providers is aware of the serious consequences of anoxia subsequent to acute airway obstruction, and is trained to manage such situations when they occur. Nonetheless, a patent airway is not always attainable. Percutaneous needle laryngostomy with translaryngeal ventilation has been widely advocated for emergency ventilation in desperate situations in which other efforts, including intubation have failed. A review of literature suggested that using a large bore (> 18 Ga) needle/catheter with a jet ventilator, or alternatively connecting it to an oxygen source of high pressure (40-50 psi; i.e. anesthesia machine, wall outlet etc.) via a low compliance tubing will effectively resuscitate an animal or patient. However, this method may expose the patients to the risk of barotrauma which has inhibited its widespread adoption. In order to assess this risk, we have conducted an in vitro study employing a simple lung simulator and an anesthesia machine. Variables of the experiment included the make of the anesthesia machine, size of the needle/catheter, degree and duration of depression of the flush valve, as well as the size of the pop-off valve opening. Based on the data obtained from our study as well as others by an extensive literature review, we have proposed some guidelines for this technique when a jet ventilator is not available.
每位麻醉提供者都清楚急性气道阻塞后缺氧的严重后果，并接受过在这种情况发生时进行处理的培训。然而，并非总能确保气道通畅。经皮穿刺针行喉造口术并经喉通气已被广泛提倡用于包括插管在内的其他方法均告失败的绝境中的紧急通气。文献综述表明，使用大口径（>18G）的针/导管与喷射通气机，或者通过低顺应性管道将其连接到高压氧气源（40-50磅力/平方英寸；即麻醉机、墙壁插座等）可有效使动物或患者复苏。然而，这种方法可能使患者面临气压伤的风险，这限制了其广泛应用。为了评估这种风险，我们使用简单的肺模拟器和麻醉机进行了一项体外研究。实验变量包括麻醉机的品牌、针/导管的尺寸、冲洗阀下压的程度和持续时间，以及安全阀开口的大小。基于我们的研究以及通过广泛文献综述获得的其他研究的数据，我们针对在没有喷射通气机的情况下使用该技术提出了一些指导原则。
