[Continuous flow apnoeic ventilation via intratracheal oxygen insufflation].

Background: In patients with disturbed gas-exchange (e.g. COPD) intratracheal oxygen insufflation (ITO2) improves oxygenation and reduces the minute ventilation. We use a bronchoscopic technique of intratracheal catheter placement in unintubated patients. In a patient with a pink-puffer emphysema after endoscopical insertion of the catheter ITO2 induced a "continuous flow apnoeic ventilation" (CFAV).

Case Report: A patient (female, 58 years) with a pink-puffer emphysema was admitted to the ICU with acute on chronic respiratory failure due to acute laryngitis. Because of laryngitis associated upper airway obstruction a non-invasive mechanical ventilation could not be performed. The ensuing high flow ITO2 (10 l/min) induced a CFAV characterized by no chest wall movement and adequate ventilation as reflected by stable, elevated PaCO2 (between 118 and 125 mm Hg), which could be maintained for 4 hours. After an ensuing short-term invasive mechanical ventilation and the administration of high dose glucocorticoids the patient was successfully extubated and the clinical status improved continuously.

Conclusion: In a patient with an acute on chronic respiratory failure due to end-stage emphysema ITO2 induced CFAV and stabilized the clinical status. Especially in patients with end-stage emphysema, who are likely to be difficult to be weaned from the respirator ITO2 may be a feasible technique in order to bridge an emergency situation.