Ventilation via the 2.4 mm internal diameter Tritube (R) with cuff - new possibilities in airway management

Background: A small tube may facilitate tracheal intubation and improve surgical access. We describe our initial experience with the Tritube (R) that is a novel cuffed endotracheal tube with a 2.4 mm internal diameter.

Methods: The Tritube (R) was used in seven adult Ear-Nose-and Throat surgical patients with airway narrowing or whose surgical access was facilitated by this small-bore endotracheal tube. Ventilation through Tritube (R) is performed with the manually operated Ventrain (R)-ventilator that allows active suctioning during expiration, therefore facilitating normoventilation through small diameter airways.

Results: The small diameter of Tritube (R) seemed to improve glottis visualisation during intubations and gave excellent working conditions for surgery. Two patients were intubated awake with a flexible scope and a guide wire or with an angulated video laryngoscope. One patient had almost complete glottic occlusion that just allowed for passage of the Tritube (R). Adequate ventilation was achieved in all patients and intratracheal pressure was kept between 5 and 20 cm H2O. The tube was well tolerated after emergence from anaesthesia and kept intratracheally in five awake patients in the post-operative recovery unit, in one case for more than 1 h. Ventilating with Ventrain (R) through Tritube (R) demands meticulous breath by breath measurement and adjustment of the intratracheal pressure.

Conclusion: The 2.4 mm internal diameter Tritube (R) seems to facilitate tracheal intubation and to provide unprecedented view of the intubated airway during oral, pharyngeal, laryngeal or tracheal procedures in adults. This technique has the potential to replace temporary tracheostomy, jet-ventilation or extra-corporal membrane oxygenation in selected patients.