Ventilating with tracheal gas insufflation and periodic tracheal occlusion during sleep and wakefulness

Introduction: The current invasive and noninvasive methods for delivering long-term ventilatory support rely on cumbersome patient interfaces that may interfere with upper airway function. To overcome these limitations, a novel system was developed to ventilate conscious, spontaneously breathing dogs through a self-contained cuffed cannula that was used for tracheal gas insufflation (TGI) and periodic tracheal occlusion (PTO). We hypothesized that TGI + PTO would provide greater ventilatory support than would TGI alone and that its effect would be more pronounced during sleep than wakefulness. Methods: Chronically tracheostomized dogs were monitored for sleep (ie, EEG, electro-oculogram, and nuchal electromyogram) and breathing (ie, tracheal pressure [Ptr] and upper airway flow via snout mask). A thin transtracheal cannula housed within a cuffed tracheostomy tube was used for TGI and PTO monitoring. VE, gas exchange, and breathing patterns were examined during sleep and wakefulness at baseline (ie, no TGI) and during the application of TGI alone (at 5, 10, and 15 L/min) and the application of TGI + PTO. Results: Compared to baseline breathing without TGI, TGI at 5, 10, and 15 L/min decreased minute ventilation without influencing PaCO₂. In contrast, TGI + PTO led to progressive increases in ventilation, positive Ptr swings, and decreases in PaCO₂ as the flow rate was increased during sleep and wakefulness. Moreover, spontaneous breathing efforts ceased during TGI + PTO at flow rates of 10 and 15 L/min during wakefulness, and at all flow rates during sleep. Conclusions: The findings indicate that TGI + PTO can fully support ventilation in a spontaneously breathing canine model during sleep and wakefulness. Its streamlined interface could ultimately prove to be clinically significant, once technical concerns are addressed.