BACKGROUND The difficult airway is frequently encountered across many scenarios. The extreme form is a "cannot intubate and cannot oxygenate" scenario, which lacks a reliable rescue technique. Previous case reports or studies with small sample sizes indicate the feasibility and efficiency of an endotracheal tube in the pharynx (TTIP) to ventilate patients. We hypothesize that ventilation via TTIP is an effective rescue technique for failed mask ventilation. METHOD One hundred forty-seven patients with potentially difficult airways were randomly assigned to the sequence (Tube first) of tube first ventilation via TTIP for 1 minute after induction, followed by via mask ventilation for 1 minute or in reverse sequence (Mask first). The ventilation was done with pressure control mode, a peak inspiratory airway pressure of 20 cmH2O, an inspiratory to expiratory time ratio of 1:2, and a respiratory rate of 10 breaths/min. RESULTS A total of 136 patients underwent final analysis. The overall success rate (primary outcome) of ventilation via TTIP and mask, defined as the presence of expired carbon dioxide, was 93.4% (127/136) and 84.6% (115/136), respectively (P = .02). The success rate, 85.7% (6/7), of mask ventilation rescuing a failed TTIP ventilation and 100% (13/13) of TTIP rescuing a failed mask ventilation were comparable (P = .35). CONCLUSIONS The success rates of TTIP and mask ventilation are comparable. Ventilation via TTIP could be an alternative rescue technique for managing a difficult airway.

中文翻译：

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在潜在困难气道患者中，通过咽部气管插管通气与面罩通气的有效性：一项随机、交叉和盲法试验。


背景 困难的气道在许多情况下经常遇到。极端形式是“无法插管且无法氧合”的情况，缺乏可靠的救援技术。既往病例报告或小样本量研究表明咽内气管插管 （TTIP） 为患者通气的可行性和有效性。我们假设通过 TTIP 通气是面罩通气失败的有效抢救技术。方法 将 147 例潜在困难气道患者随机分配到诱导后通过 TTIP 通气 1 分钟的先管通气顺序 （管优先），然后通过面罩通气 1 分钟或以相反顺序 （面罩优先）。通气采用压力控制模式，吸气气道峰值压力为 20 cmH2O，吸气与呼气时间比为 1：2，呼吸频率为 10 次呼吸/分钟。结果 共有 136 例患者接受了最终分析。通过 TTIP 和面罩通气的总体成功率 （主要结果） 定义为呼出二氧化碳的存在，分别为 93.4% （127/136） 和 84.6% （115/136） （P = .02）。面罩通气挽救失败的 TTIP 通气的成功率为 85.7% （6/7），TTIP 挽救失败的面罩通气的成功率为 100% （13/13） 相当 （P = .35）。结论 TTIP 和面罩通气的成功率相当。通过 TTIP 通气可能是管理困难气道的替代救援技术。