Wong Carrie F P, Yuen Vivian M, Wong Gordon T C, To Jensen, Irwin Michael G
Department of Anaesthesiology, Queen Mary Hospital, Hong Kong, China.
Paediatr Anaesth. 2014 Feb;24(2):208-13. doi: 10.1111/pan.12289. Epub 2013 Nov 13.
Limited information is available on the management of the 'cannot intubate, cannot ventilate' (CICV) situation in infants. We compared the time to achieve adequate oxygenation following rescue ventilation using the Enk oxygen flow modulator (OFM) with a jet ventilator in a simulated CICV situation using the rabbit as an infant respiratory model.
Following institutional ethics committee approval, needle cricothyrotomy was performed under direct vision in nine anesthetized rabbits following surgical exposure of the larynx. After ensuring adequate level of anesthesia and analgesia, and confirming proper positioning of the 18G cannula, apnea was induced by the administration of myorelaxant and the SpO2 was allowed to drop to 75% before initiating rescue ventilation via either the OFM or jet ventilator.
Five rabbits were ventilated with the OFM and four with the jet ventilator. Ventilation was maintained with either device for 15 min. All rabbits were successfully rescued using either device. There was no statistical difference in the time required for SpO2 to return to 80%, 85%, 90%, and 95%.
Both devices facilitated successful rescue ventilation through a needle cricothyrotomy.
关于婴儿“无法插管、无法通气”(CICV)情况的处理,现有信息有限。我们在以兔子作为婴儿呼吸模型的模拟CICV情况下,比较了使用恩克氧气流量调节器(OFM)与喷射呼吸机进行抢救通气后达到充分氧合的时间。
经机构伦理委员会批准,在九只麻醉的兔子直视下进行针状环甲膜切开术,术前需暴露喉部。确保麻醉和镇痛水平适当,并确认18G套管位置正确后,给予肌松剂诱导呼吸暂停,使血氧饱和度(SpO2)降至75%,然后通过OFM或喷射呼吸机开始抢救通气。
五只兔子使用OFM通气,四只使用喷射呼吸机通气。两种设备均维持通气15分钟。使用任一设备均成功抢救了所有兔子。SpO2恢复到80%、85%、90%和95%所需的时间无统计学差异。
两种设备均有助于通过针状环甲膜切开术成功进行抢救通气。