Transtracheal jet ventilation in patients with severe airway compromise and stridor.

Editor—We read with interest the article on transtracheal jet ventilation (TTJV) in patients with severe airway compromise by Ross-Anderson and colleagues. We agree with the authors regarding the enormous value of the pause pressure protection offered by automated jet ventilators in the elective setting. Protection from barotrauma is just as important in the emergency obstructed airway. The Ventrain (Dolphys Medical, Eindhoven, The Netherlands) is a new device which offers an alternative approach to the prevention of major pressure-related complications. It was first presented at the Difficult Airway Society meeting in Liverpool in 2008 and is now commercially available from Inspiration Healthcare. It is a single-use TTJV device marketed for use in emergency complete airway obstruction scenarios. It consists of a handheld device with tubing to connect one end to an oxygen supply and the other to a narrow bore transtracheal catheter. It allows not only inspiration but also active expiration by generating suction using the Venturi effect, thus reducing the risk of barotrauma caused by inadequate exhalation. We would be interested in the thoughts of the authors about the place of this device in emergency and elective airway management.