Ventilation strategies for front of neck airway rescue: an in silico study

Laviola, Marianna; Niklas, Christian; Das, Anup; Bates, Declan G; Hardman, Jonathan G

Abstract

Background. During induction of general anaesthesia a “can’t intubate, can’t oxygenate” (CICO) situation can arise, leading to severe hypoxaemia. Evidence is scarce to guide ventilation strategies for small-bore front of neck airways that ensure effective oxygenation without risking lung damage and cardiovascular depression.

Methods. Fifty virtual subjects were configured using a high-fidelity computational model of the cardiovascular and pulmonary systems. Each subject breathed 100% oxygen for 3 minutes and then became apnoeic, with an obstructed upper airway. When arterial oxygen saturation reached 40%, front of neck airway access was simulated with various configurations. We examined the effect of several ventilation strategies on re-oxygenation, pulmonary pressures, cardiovascular function and oxygen delivery.

Results. Re-oxygenation was achieved in all ventilation strategies. Smaller airway configurations led to dynamic hyperinflation for a wide range of ventilation strategies. This effect was absent in the airways with larger internal diameter (≥3 mm). Intrapulmonary pressures rose quickly to supra-physiological values with the smallest airways, resulting in pronounced cardio-circulatory depression (cardiac output

Citation

Laviola, M., Niklas, C., Das, A., Bates, D. G., & Hardman, J. G. (2021). Ventilation strategies for front of neck airway rescue: an in silico study. British Journal of Anaesthesia, 126(6), 1226-1236. https://doi.org/10.1016/j.bja.2021.01.030

• Journal Article Type: Article
• Acceptance Date: Jan 18, 2021
• Online Publication Date: Mar 3, 2021
• Publication Date: Jun 1, 2021
• Deposit Date: Jan 20, 2021
• Publicly Available Date: Mar 4, 2022
• Journal: British Journal of Anaesthesia
• Print ISSN: 0007-0912
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 126
• Issue: 6
• Pages: 1226-1236
• DOI: https://doi.org/10.1016/j.bja.2021.01.030
• Public URL: https://nottingham-repository.worktribe.com/output/5247911
• Publisher URL: https://bjanaesthesia.org/article/S0007-0912(21)00081-7/fulltext