Transtracheal oxygen therapy
- Michael D Schwartz, MD, FCCP, FCCM
Michael D Schwartz, MD, FCCP, FCCM
- Professor of Medicine
- National Jewish Health
- Kent L Christopher, MD, RRT, FCCP, FAARC
Kent L Christopher, MD, RRT, FCCP, FAARC
- Clinical Professor of Medicine
- University of Colorado Denver, School of Medicine
- Section Editors
- James K Stoller, MD, MS
James K Stoller, MD, MS
- Section Editor — Chronic Obstructive Pulmonary Disease
- Jean Wall Bennett Professor of Medicine, Samson Global Leadership Academy Endowed Chair
- Cleveland Clinic Lerner College of Medicine
- Chairman, Education Institute, Cleveland Clinic
- Praveen N Mathur, MB;BS
Praveen N Mathur, MB;BS
- Section Editor — Interventional Pulmonology
- Professor of Clinical Medicine
- Indiana University School of Medicine
Transtracheal oxygen (TTO) therapy refers to the delivery of long-term oxygen therapy (LTOT) through a transtracheal catheter (picture 1). It is an alternative to conventional LTOT, which is delivered through a nasal cannula.
The benefits of TTO therapy, patient selection, complications, and reimbursement are discussed in this topic review. Other issues related to LTOT are discussed separately. (See "Long-term supplemental oxygen therapy" and "Traveling with oxygen aboard commercial air carriers" and "Portable oxygen delivery and oxygen conserving devices" and "The evaluation, diagnosis, and treatment of the adult patient with acute hypercapnic respiratory failure".)
Transtracheal oxygen (TTO) therapy offers several potential benefits . Most studies that have examined the efficacy of TTO have used the subject as his or her own control. In the short-term physiologic studies, patients with an existing transtracheocutaneous fistula usually received interventions related to tracheal gas delivery in a random order, and then were compared to controls with no tracheal flow [2,3]. In the long-term clinical studies, data collected after initiation of TTO therapy were compared to data collected while the patient was receiving LTOT by nasal cannula [4-8]. One trial randomized 43 patients to receive TTO or long-term oxygen therapy (LTOT) via nasal cannula for the duration of the trial .
TTO was found to have the following effects when compared to LTOT delivered via nasal cannula (table 1):
●Reduces the oxygen flow that is required to achieve the same arterial oxyhemoglobin saturation, both at rest (55 percent reduction) and during exercise (30 percent reduction) 
Subscribers log in hereLiterature review current through: May 2017. | This topic last updated: May 11, 2017.References
- Christopher KL. Transtracheal oxygen catheter placement and management. In: Principles and Practice of Interventional Pulmonology, Ernst A, Herth F. (Eds), Springer, New York 2013. p.705.
- Bergofsky EH, Hurewitz AN. Airway insufflation: physiologic effects on acute and chronic gas exchange in humans. Am Rev Respir Dis 1989; 140:885.
- Dewan NA, Bell CW. Effect of low flow and high flow oxygen delivery on exercise tolerance and sensation of dyspnea. A study comparing the transtracheal catheter and nasal prongs. Chest 1994; 105:1061.
- Christopher KL, Spofford BT, Petrun MD, et al. A program for transtracheal oxygen delivery. Assessment of safety and efficacy. Ann Intern Med 1987; 107:802.
- Hoffman LA, Wesmiller SW, Sciurba FC, et al. Nasal cannula and transtracheal oxygen delivery. A comparison of patient response after 6 months of each technique. Am Rev Respir Dis 1992; 145:827.
- O'Donohue WJ Jr. Effect of oxygen therapy on increasing arterial oxygen tension in hypoxemic patients with stable chronic obstructive pulmonary disease while breathing ambient air. Chest 1991; 100:968.
- Christopher KL, Spofford BT, Brannin PK, Petty TL. Transtracheal oxygen therapy for refractory hypoxemia. JAMA 1986; 256:494.
- Kampelmacher MJ, Deenstra M, van Kesteren RG, et al. Transtracheal oxygen therapy: an effective and safe alternative to nasal oxygen administration. Eur Respir J 1997; 10:828.
- Bloom BS, Daniel JM, Wiseman M, et al. Transtracheal oxygen delivery and patients with chronic obstructive pulmonary disease. Respir Med 1989; 83:281.
- Benditt J, Pollock M, Roa J, Celli B. Transtracheal delivery of gas decreases the oxygen cost of breathing. Am Rev Respir Dis 1993; 147:1207.
- Couser JI Jr, Make BJ. Transtracheal oxygen decreases inspired minute ventilation. Am Rev Respir Dis 1989; 139:627.
- Hurewitz AN, Bergofsky EH, Vomero E. Airway insufflation. Increasing flow rates progressively reduce dead space in respiratory failure. Am Rev Respir Dis 1991; 144:1229.
- Spofford B, Christopher KL, Goodman JR. Transtracheal Oxygen Therapy. In: Problems in Respiratory Care - The Current Status of Oxygen Therapy, Christopher KL (Ed), J.B. Lippincott Company, Philadelphia 1990. p.600.
- Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Intern Med 1980; 93:391.
- Reinke, LF, Hoffman, LA. Transtracheal oxygen: Patient management strategies. Respir Care Prac 1992; 5:66.
- Christopher KL, VanHooser DT, Jorgenson SJ, et al. Preliminary observations of transtracheal augmented ventilation for chronic severe respiratory disease. Respir Care 2001; 46:15.
- Brack T, Senn O, Russi EW, Bloch KE. Transtracheal high-flow insufflation supports spontaneous respiration in chronic respiratory failure. Chest 2005; 127:98.
- Christopher KL, Schwartz MD. Transtracheal oxygen therapy. Chest 2011; 139:435.
- Harris RJ. Transtracheal oxygen therapy success. Chest 2011; 140:563.
- Schwartz MD, Make B. Long-term oxygen therapy: whatever happened to transtracheal oxygen? COPD 2009; 6:226.
- Hoffman LA, Johnson JT, Wesmiller SW, et al. Transtracheal delivery of oxygen: efficacy and safety for long-term continuous therapy. Ann Otol Rhinol Laryngol 1991; 100:108.
- Hoffman LA, Wesmiller SW. Transtracheal oxygen. In: Portable Oxygen Therapy Including Oxygen Conserving Methodology, Tiep BL (Ed), Futura Publishing Co, Mount Kisco, NY 1991.
- Wesmiller SW, Hoffman LA, Wiseman M. Understanding transtracheal oxygen delivery. Nursing 1989; 19:43.
- SCOOP Transtracheal Oxygen Therapy. Clinical Guide for the Fast Tract Insertion Technique. Transtracheal Systems, Inc., Englewood, CO, 1997.
- Lipkin AF, Christopher KL, Diehl S, et al. Otolaryngologist's role in transtracheal oxygen therapy: the minitrach procedure. Otolaryngol Head Neck Surg 1996; 115:447.
- Tiep BL, Christopher KL, Spofford BT, et al. Pulsed nasal and transtracheal oxygen delivery. Chest 1990; 97:364.
- Yaeger ES, Goodman S, Hoddes E, Christopher KL. Oxygen therapy using pulse and continuous flow with a transtracheal catheter and a nasal cannula. Chest 1994; 106:854.
- Orvidas LJ, Kasperbauer JL, Staats BA, Olsen KD. Long-term clinical experience with transtracheal oxygen catheters. Mayo Clin Proc 1998; 73:739.
- Heimlich HJ, Carr GC. The micro-trach. A seven-year experience with transtracheal oxygen therapy. Chest 1989; 95:1008.
- Couser JI Jr, Make BJ. Respiratory tract infection complicating transtracheal oxygen therapy. Chest 1992; 101:273.
- Fletcher EC, Nickeson D, Costarangos-Galarza C. Endotracheal mass resulting from a transtracheal oxygen catheter. Chest 1988; 93:438.
- Burton GG, Wagshul FA, Henderson D, Kime SW. Fatal airway obstruction caused by a mucous ball from a transtracheal oxygen catheter. Chest 1991; 99:1520.
- Harrow EM, Oldenburg FA, Lingenfelter MS, Leonard J. Respiratory failure and cor pulmonale associated with tracheal mucoid accumulation from a SCOOP transtracheal oxygen catheter. Chest 1992; 101:580.
- Roth BJ, Irvine TW, Liening DA, et al. Acute respiratory compromise resulting from tracheal mucous impaction secondary to a transtracheal oxygen catheter. Chest 1992; 101:1465.
- de Groot RE, Dik H, de Groot HG, Bakker W. A nearly fatal tracheal obstruction resulting from a transtracheal oxygen catheter. Chest 1993; 104:1634.
- Ulstad DR, Koppin J. Massive atelectasis with respiratory arrest due to transtracheal oxygen catheter-related mass formation. Chest 1994; 106:982.
- Menon AS, Carlin BW, Kaplan PD. Tracheal perforation. A complication associated with transtracheal oxygen therapy. Chest 1993; 104:636.
- Kristo DA, Turner JF, Hugler R. Transtracheal oxygen catheterization with pneumomediastinum and sudden death. Chest 1996; 110:844.
- PATIENT SELECTION
- GENERAL APPROACH
- Phase I
- - Preprocedure evaluation
- - Patient education
- Phase II
- - Modified Seldinger technique
- - Lipkin procedure
- - Comparison
- Phase III
- - Tract loss
- - Mucus accumulation
- Phase IV
- GENERAL COMPLICATIONS
- SUMMARY AND RECOMMENDATIONS