Division of Pulmonary/Critical Care, University of Colorado Health Sciences Center, Denver, CO.
Department of Pulmonary/Critical Care, National Jewish Health, Denver, CO.
Chest. 2011 Feb;139(2):435-440. doi: 10.1378/chest.10-1373.
Transtracheal oxygen therapy (TTO) has been used for long-term oxygen therapy for nearly 30 years. Numerous investigators have explored the potential benefits of TTO. Those results are reviewed in this article. TTO is best viewed not as a catheter but as a program for care. This article discusses patient selection for TTO. Publications evaluating complications are reviewed. In the past, a modified Seldinger technique (MST) was used for the creation of the tracheocutaneous fistula. The rather long program required for tract maturation with MST was labor-intensive and required substantial patient education and monitoring, particularly during the immature tract phase. Minor complications were not infrequent. More recently, the Lipkin method has been used to create a surgical tract under conscious sedation with topical anesthesia. The procedure is safe and well tolerated. Transtracheal oxygen is initiated the day following the procedure. Similarly, the tract matures in 7 to 10 days rather than the 6 to 8 weeks with MST. More rapid healing time and superior tract characteristics substantially reduce complications. The TTO program tailored for the Lipkin procedure is shortened, streamlined, and much less labor-intensive. Optimal outcomes with the TTO program require a committed pulmonologist, respiratory therapist, nurse, and surgeon (for the Lipkin procedure). This article discusses new directions in the use of transtracheal gas delivery, including the management of obstructive sleep apnea. Preliminary investigations regarding transtracheal augmented ventilation are presented. These include nocturnal use in severe chronic lung disease and liberation from prolonged mechanical ventilation.
经气管氧疗（TTO）已用于长期氧疗近 30 年。许多研究人员探讨了 TTO 的潜在益处。本文综述了这些结果。TTO 最好被视为一种护理方案，而不是一种导管。本文讨论了 TTO 的患者选择。综述了评估并发症的出版物。过去，改良 Seldinger 技术（MST）用于创建气管皮瘘。MST 所需的成熟通道的相当长的方案是劳动密集型的，需要大量的患者教育和监测，特别是在不成熟的通道阶段。小并发症并不罕见。最近，Lipkin 方法已用于在局部麻醉下清醒镇静下创建手术通道。该程序是安全且耐受良好的。TTO 于手术后的第二天开始。同样，该通道在 7 到 10 天内成熟，而 MST 则需要 6 到 8 周。更快的愈合时间和更好的通道特征大大降低了并发症的发生率。为 Lipkin 手术量身定制的 TTO 方案缩短、简化，并且劳动强度大大降低。TTO 方案的最佳结果需要一位敬业的肺病专家、呼吸治疗师、护士和外科医生（用于 Lipkin 手术）。本文讨论了经气管气体输送的新方向，包括阻塞性睡眠呼吸暂停的管理。介绍了经气管增强通气的初步研究。这些包括在严重慢性肺部疾病中的夜间使用以及从长时间机械通气中解脱。
