Small Lumen

Surgical and lung mechanical benefits of Tritube and FCV during laryngeal surgery

In the first randomized controlled trial Dr. Schmidt and colleagues showed clear clinical benefit of using Tritube and FCV® over using a microlaryngeal tube (MLT-6) and Volume-Controlled Ventilation (VCV) in patients undergoing laryngeal surgery. 26

Tritube significantly reduced the concealment of laryngeal structures and thereby improved surgical conditions for surgeons with a lower level of expertise. Furthermore, the authors demonstrated that FCV® enhanced lung aeration and improved the respiratory system compliance, while using similar PEEP and a lower inspiratory plateau pressure. 26

Glottic visibility for laryngeal surgery:  Tritube vs. microlaryngeal tube

  • Tritube® improves surgical conditions for surgeons.25,26,28,91,93
  • FCV® Technology enhances alveolar recruitment and improves lung aeration compared to conventional ventilation modes . 1-6,10,13,18,26

Ultrathin Tritube allowed safe intubation and ventilation in extremely narrow airway

In a patient with extreme airway obstruction due to a huge thyroid enlargement, Evone and Tritube prevented the use of ECMO to allow required surgery, as reported by Dr. Nabil Shallik (Hamad Medical Corporation, Qatar). Preoperative examination of the patient revealed a severe tracheal stenosis with a residual airway opening of only 4 mm, excluding the use of conventional endotracheal tubes to apply controlled ventilation. Instead, Tritube could be passed through the stenosis and allowed adequate ventilation using Evone during the six hour surgery 35

Shallik et al. Qatar Med J. January 2021 | Volume 2020 | Article 48 35

Potential Benefits Tritube®

The following benefits as compared to Volume Controlled Ventilation (VCV) and Pressure Controlled Ventilation (PCV) with conventional endotracheal tubes may be expected while ventilating patients in FCV® mode with ultrathin Tritube®

  • Provides an easier intubation especially in difficult airways 25, 28, 45, 91, 93
  • Provides unprecedented view of the intubated airway during oral, pharyngeal, laryngeal or tracheal procedures in adults 45
  • Provides improved surgical exposure as compared to an MLT-6 26, 28
  • Clear sigh t and non-vibrating vocal cord
    26, 28, 45, 46, 91,93
  • Offers several new surgical options for treatment during ENT/laryngeal/tracheal surgery 27, 30, 31, 33-37, 45, 46, 91, 92, 93
  • Allows awake tracheal placement 36, 45
  • Allows adequate ventilation of adults in combination with Ventrain® or Evone®
    25-30, 33–38, 45-55, 91-93
  • Is well tolerated in awake patients (>1 hour after surgery!) at least as well tolerated as an airway exchange catheter 27, 28, 45
  • Allows talking of intubated patients 27, 28, 45
  • Allows mask ventilation of intubated patients
  • Reduces the risk on aerosol generation as compared to ventilation in an open airway 38, 91

“Tritube makes my life so much easier, as it provides a great view and an effective ventilation in the compromised airway”

Prof. Dr. Hans Mahieu
Laryngologist, Meander Hospital Amersfoort, The Netherlands

Jet Mode

The Jet cycle is governed by three operator settings being:

  • Frequency
  • Inspiration Percentage
  • Driving Pressure

The maximum driving pressure is limited to 1.5 Bar.

  • Jet Mode, can be postoperatively used to liberate the patient from FCV® mechanical ventilation with Tritube® to stimulate spontaneous breathing. The cuff of Tritube® should be fully deflated to enable expiratory gases to freely egress.
  • Double lumen laser Jet catheter.

Jet Mode intratracheal pressur: typical sequence of Jet breathing cycles is shown.