Correspondence |

Transtracheal Oxygen Therapy SuccessTranstracheal Oxygen Therapy Success FREE TO VIEW

Richard J. Harris, MD
Author and Funding Information

Correspondence to: Richard J. Harris, MD, 6169 Los Felinos Circle, El Paso, TX 79912-1921; e-mail: harris1@elp.rr.com

Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

© 2011 American College of Chest Physicians

Chest. 2011;140(2):563. doi:10.1378/chest.11-0630
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To the Editor:

I am writing in regard to the article by Christopher and Schwartz1 on transtracheal oxygen therapy (TTO) in a recent issue of CHEST (February 2011). Long-term oxygen therapy (LTOT) by the transtracheal route has not been given enough credit by the medical community. I speak from experience as a retired board-certified general surgeon with severe COPD who is receiving LTOT.

I required nocturnal oxygen using a nasal cannula for 8 years but suffered with recurrent epistaxis due to the nasal cannula. One year ago, after an acute exacerbation, I required continuous oxygen, and this presented a dilemma due to the ongoing epistaxis. My pulmonologist did not offer TTO as an alternate method of LTOT. I researched oxygen therapy on the Internet and found Transtracheal Systems. I contacted John Goodman, RRT, and after I explained my situation, he referred me to Dr Michael Schwartz at National Jewish Health in Denver, Colorado. Dr Schwartz spent a great deal of time with me on the telephone, but I felt Denver’s altitude might be problematic for me. I sought established transtracheal programs in Texas, New Mexico, and Arizona without success.

I then located an otorhinolaryngologist in Phoenix, Arizona, who had experience performing the (preferred) Lipkin surgical procedure, so I went to Phoenix. The procedure went very well, and I returned to my home in El Paso, Texas. After 10 days, I started changing my catheter per protocol and was able to do just fine. I am back now to most normal activities, including golf twice a week, pulmonary rehabilitation twice weekly, and more.

Before TTO, my hemoglobin level was 17.5, and my hematocrit value was 51%; today, my hemoglobin level is 14.9, and my hematocrit value is 40.9%. I require a setting of 2 while sedentary and 3 when ambulatory or exercising using a liquid oxygen portable delivery system on intermittent flow. I use continuous flow at 2.5 L/min for sleep.

TTO requires teamwork, and the pulmonologist is the linchpin. It is the pulmonologist who must know that such a procedure does exist and that it is a viable and often a preferable modality. Patient selection is extremely important, and pulmonologists should know that TTO is not a therapy intended only for the patient with refractory hypoxemia. Finally, the patient must be highly motivated, have some manual skill, and have a great deal of confidence in his or her pulmonologist. Again, I thank CHEST for publishing this excellent article and the authors for their fine work.

Christopher KL, Schwartz MD. Transtracheal oxygen therapy. Chest. 2011;1392:435-440. [CrossRef] [PubMed]




Christopher KL, Schwartz MD. Transtracheal oxygen therapy. Chest. 2011;1392:435-440. [CrossRef] [PubMed]
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