Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Royal Columbian Hospital, 330 East Columbia Street, New Westminster, BC, V3L 1W7, Canada.
Can J Anaesth. 2011 Jun;58(6):560-8. doi: 10.1007/s12630-011-9488-4. Epub 2011 Apr 5.
An airway exchange catheter (AEC) may be employed as a conduit for endotracheal tube placement and for oxygen insufflation or jet ventilation via its lumen. The recent barotrauma-related death of a young healthy patient receiving oxygen insufflated through an AEC prompted the Chief Coroner of Ontario to seek guidelines regarding their use. A literature search was undertaken using a number of search strategies to investigate both the efficacy and complications associated with supplying oxygen through an AEC.
No studies were found comparing either oxygen insufflation or jet-ventilation through an AEC to any standard forms of oxygen therapy. The only case series found using AEC jet ventilation reported that 11% of patients sustained pulmonary barotrauma. Thirteen case reports documented jet ventilation as being associated with pneumothorax, pneumomediastinum, pneumoperitoneum, cardiovascular collapse, and death. In three case series (totalling 76 adults and 20 children) using only oxygen insufflation, no complications were reported.
Jet ventilation through an AEC may be associated with a significant risk of barotrauma. Oxygen insufflation appears to be associated with a lower risk, but it is not risk-free. The authors caution against the use of an AEC to administer oxygen failing the proven benefit of its use over the use of standard oxygen therapies. Should a patient decompensate with an AEC in situ, tracheal re-intubation is the key management strategy. Supplemental oxygen can be provided using standard techniques prior to tracheal intubation or between attempts. Under emergency circumstances, oxygen insufflation or manual ventilation through an AEC may be considered provided vigilance for barotrauma is maintained and re-intubation is not delayed.
气道交换导管（AEC）可作为气管内导管放置的通道，并通过其管腔进行氧气灌输或射流通气。最近，一名年轻健康的患者在接受通过 AEC 灌输氧气时发生与气压伤相关的死亡事件，促使安大略省首席验尸官寻求有关其使用的指南。进行了一项文献检索，使用了多种搜索策略来调查通过 AEC 供应氧气的疗效和相关并发症。
没有研究比较通过 AEC 进行氧气灌输或射流通气与任何标准形式的氧气治疗。唯一发现的使用 AEC 射流通气的病例系列报告称，11%的患者发生了肺气压伤。13 份病例报告记录了射流通气与气胸、纵隔气肿、气腹、心血管崩溃和死亡有关。在仅使用氧气灌输的三个病例系列（共 76 名成人和 20 名儿童）中，没有报告并发症。
通过 AEC 进行射流通气可能与气压伤的风险显著相关。氧气灌输似乎风险较低，但并非无风险。作者警告不要在没有证明其使用优于标准氧气治疗的益处的情况下，使用 AEC 来进行氧气治疗。如果患者在 AEC 在位时出现失代偿，气管重新插管是关键的管理策略。在气管插管之前或尝试之间，可以使用标准技术提供补充氧气。在紧急情况下，可以考虑通过 AEC 进行氧气灌输或手动通气，但要保持对气压伤的警惕，并且不要延迟重新插管。
