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Tube tip in pharynx (TTIP) ventilation: Simple establishment of ventilation in case of failed mask ventilation

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Mask ventilation occasionally fails. Alternative readily available and simple methods to establish ventilation in these cases are needed. Methods: 

Retrospective description of cases in which a new technique, tube tip in pharynx (TTIP) ventilation, was employed for restoring ventilation in case of failed facemask ventilation during induction of anaesthesia. The technique involves a standard endotracheal tube and can be performed single-handed: A standard endotracheal tube was placed via the mouth with the tip in the pharynx and the cuff was inflated. By placing the fourth and fifth fingers below the ramus of the mandible, the third finger below the lower lip, the second finger above the upper lip and on one side of the nose and the first finger on the other side of the nose, an open airway is restored. Chin lift is inherent in the grip, thus contributing to opening of the airway. Results: 

In all four cases of failed mask ventilation the anaesthetist could establish an open airway and subsequent ventilation without the need for an assistant. There were no indications of gastric insufflation. Conclusion: 

The TTIP technique established ventilation in all four patients after abandoned facemask ventilation. The technique only involves one person and an endotracheal tube and warrants to be included in the armamentarium of anaesthetists.

Further prospective studies are needed to refine the technique and delimit its indications.

Keywords: Airway management; difficult airway; mask ventilation; rescue airway; rescue ventilation

Document Type: Research Article


Affiliations: Department of Anaesthesia and Operating Theatre Services, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

Publication date: 2005-02-01

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