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Tracheal Gas Insufflation

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Acute Respiratory Distress Syndrome

Part of the book series: NATO ASI Series ((NSSA,volume 297))

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Abstract

Tracheal gas insufflation (TGI) is the continuous or phasic insufflation of fresh gas into the central airways for the purpose of improving the efficiency of alveolar ventilation andJor minimizing the ventilatory pressure requirement. TGI usually employs modest flow rates of 2 to 15 L/min. Two mechanisms are responsible for improving the efficacy of conventional tidal breaths during TGI (1-3). First, fresh gas introduced by the catheter during expiration can dilute the CO2 stored in the series (anatomic) deadspace compartment proximal to its tip. Second, at high catheter flow rates, turbulence generated at the tip of the catheter can enhance gas mixing in regions distant to the catheter tip, thereby contributing to carbon dioxide removal. TGI is unlikely to be very effective when the alveolar as opposed to the series compartment dominates the total physiologic deadspace; yet at small tidal volumes (whenever series deadspace is especially high) or when alveolar ventilation is very low, TGI should be helpful (10). Many investigators have attempted to combine flow through an intratracheal catheter with conventional mechanical ventilation (CMV) techniques (5-13) as well as high frequency jet (14) and oscillatory (15) ventilation. This approach takes advantage of improved ventilatory efficiency due to anatomic deadspace washout as well as enhanced mixing due to catheter turbulence generated to permit reduction in tidal volume (VT)(11). Combining small tidal volumes with constant flow ventilation, delivers fresh gas further down the airways from the catheter site above the carina, bypassing the high-resistance central zone to achieve eucapnia at low flow rates (16). Furthermore, fresh gas introduced by the catheter improves the “efficacy” of each tidal breath.

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Author information

Authors and Affiliations

  1. Assistant Professor of Medicine, University of Minnesota, Department of Pulmonary and Critical Care St. Paul-Ramsey Medical Center, United States

    Avi Nahum M.D., Ph.D.

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  1. Avi Nahum M.D., Ph.D.
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Editors and Affiliations

  1. The University of Alabama at Birmingham, Birmingham, Alabama, USA

    Sadis Matalon

  2. University of Illinois at Chicago, Chicago, Illinois, USA

    Jacob Lasha Sznajder

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© 1998 Plenum Press, New York

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Nahum, A. (1998). Tracheal Gas Insufflation. In: Matalon, S., Sznajder, J.L. (eds) Acute Respiratory Distress Syndrome. NATO ASI Series, vol 297. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-8634-4_34

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  • DOI: https://doi.org/10.1007/978-1-4419-8634-4_34

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-306-45830-9

  • Online ISBN: 978-1-4419-8634-4

  • eBook Packages: Springer Book Archive

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