• M Berry, Y Tzeng, and C Marsland.
• Centre for Translational Physiology, University of Otago, Wellington, New Zealand Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.
• Br J Anaesth. 2014 Dec 1;113(6):1039-45.

BackgroundTemporizing oxygenation by percutaneous transtracheal ventilation (PTV) is a recommended emergency technique in 'can't intubate, can't oxygenate' (CICO) situations. Barotrauma risk increases if expiration is obstructed. The Ventrain(®) is a new PTV device that assists expiration. Our aim was to compare key physiological outcomes after PTV with the Ventrain and the Manujet(®) in a large animal obstructed airway model.MethodsFive anaesthetized sheep had post-apnoea PTV performed for 15 min using the Ventrain or Manujet with the proximal airway completely or critically obstructed, yielding four ventilation protocols per sheep. After apnoeic desaturation ([Formula: see text]70%), a 4 s rescue breath was delivered. Subsequent 2 s breaths were delivered whenever the airway pressure fell <10 cm H2O.ResultsBoth devices achieved rapid re-oxygenation. There were marked device differences (Ventrain vs Manujet) in peak airway pressures with rescue (16 vs 40 cm H2O) breaths, minute ventilation (4.7 vs 0.1 litre min(-1)), and end-protocol pH (7.34 vs 7.01). There was no clinical evidence of barotrauma in any sheep after any ventilation protocol. An equilibration phase prevented large subatmospheric intrathoracic pressure development with Ventrain ventilation.ConclusionsThe Ventrain provided stable oxygenation and effective ventilation at low airway pressures during emergency PTV in critically obstructed airways. The Manujet provided effective temporizing oxygenation in this situation with hypoventilation necessary to minimize barotrauma risk. The nature and extent of airway obstruction may not be known in a CICO emergency but an understanding of device differences may help inform optimal ventilation device and method selection.© The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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