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University Hospital Düsseldorf, Düsseldorf, Germany Medical School Hannover, Hannover, Germany
To the Editor:
We would like to thank Dr. Beattie for describing his interesting experience in the "Cannot Ventilate Cannot Intubate" scenario using a modified trumpet (1).
Five years ago, we reported a similar method (2,3). In contrast to Dr. Beattie’s approach, we used an endotracheal tube placed in a pharyngeal position (like his trumpet). We also used nearly the same grip to seal the mouth and nose. In this study, all of our patients could be ventilated sufficiently, and there was no difference in comparison with mask ventilation. When in different clinical settings an unexpected "Cannot Ventilate Cannot Intubate" situation occurred, we used this method too, until our patients were finally intubated using a fiberscope that was passed through the endotracheal tube. This strategy reduced the possibility of nasal bleeding by 50%.
Both maneuvers can be done easily. Our method does not need another tool (i.e., trumpet) and can be performed anywhere and anytime if one is aware of the technique.
References
New York University, School of Medicine, New York, New York
In Response:
We appreciate the supporting observations of Drs. Walz and Bund and reference to their 1997 publication. Our discovery of the underlying principal of operation over 15 years ago was, in fact, using an endotracheal tube, as they describe. This was discussed in our original submitted manuscript, but was eliminated in the editorial process. Our substitution of a nasal airway for the endotracheal tube was done partly to reduce trauma to nasal tissues. The modified nasal trumpet has proven to be very useful in a host of common clinical situations in which it is tolerated by lightly anesthetized or emerging patients who require temporary ventilatory support. Also, it creates opportunities for elective, asleep, nasal intubation in lieu of special intubating masks. We have used a single endotracheal tube for both the initial establishment of ventilation and the tube’s simultaneous placement by fiberoptic assistance, as Drs. Walz and Bund mention. Success with this method depends on adequacy of the annular spaces between tube and scope to permit sufficient gas flow. This can be problematic if a smaller (< 7.0-mm) tube must be used.
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