• A Ziebart, A Garcia-Bardon, J Kamuf, R Thomas, T Liu, A Schad, B Duenges, M David, and E K Hartmann.
• Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
• Anaesthesia. 2015 Oct 1; 70 (10): 1171-9.

AbstractNovel devices for small-lumen ventilation may enable effective inspiration and expiratory ventilation assistance despite airway obstruction. In this study, we investigated a porcine model of complete upper airway obstruction. After ethical approval, we randomly assigned 13 anaesthetised pigs either to small-lumen ventilation following airway obstruction (n = 8) for 30 min, or to volume-controlled ventilation (sham setting, n = 5). Small-lumen ventilation enabled adequate gas exchange over 30 min. One animal died as a result of a tension pneumothorax in this setting. Redistribution of ventilation from dorsal to central compartments and significant impairment of the distribution of ventilation/perfusion occurred. Histopathology demonstrated considerable lung injury, predominantly through differences in the dorsal dependent lung regions. Small-lumen ventilation maintained adequate gas exchange in a porcine airway obstruction model. The use of this technique for 30 min by inexperienced clinicians was associated with considerable end-expiratory collapse leading to lung injury, and may also carry the risk of severe injury. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

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