Transtracheal oxygen therapy
- Michael D Schwartz, MD, FACP, FCCP, FCCM
Michael D Schwartz, MD, FACP, FCCP, FCCM
- Associate Professor of Medicine
- National Jewish Medical and Research Center
- 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) 
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- 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