Why Don't More People Know About TTOT?
Since its introduction into medical practice in the late 1980's to the early 1990's, TTOT has not been frequently used in clinical practice. To date, it is reserved for patients who have a low blood level of oxygen that has not been successfully treated with a nasal cannula.
While advocates of the procedure strongly believe that TTOT has a place as a safe and effective approach to oxygen therapy in COPD, the TTOT procedure itself is invasive, and there are potentially serious complications associated with it, including frequent plugging of the cannula. At present, TTOT is not considered part of the standard of care for COPD treatment.
How is the Procedure Performed?
There are several approaches to TTOT, with the following being the most well-known:
- The Modified Seldinger Approach is performed under local anesthesia on an
outpatient basis. After being prepped, a small incision is made into the neck. A needle is passed through the incision and into the trachea. A wire guide is then passed through the needle, and the needle removed.
A smooth tube called a dilator is passed over the wire, and the tissues of the neck are gently stretched. The dilator is removed, and a stent is passed over the wire into the trachea, which keeps the incision from closing. The wire guide is removed and the stent is sutured to the neck. Your doctor will order a chest x-ray to confirm proper placement. You will be closely monitored for about an hour and discharged home with specific instructions for post-procedure care and safety precautions. Your doctor will want to see you one week later for a follow-up appointment when the stent will be removed and a functioning catheter inserted.
Very few hospitals continue to perform the Modified Seldinger Technique, as insurance companies only provide a modest reimbursement for it, the procedure is quite laborious, and generally involves more complications than newer methods.
- A newer method, the Fast Tract® Procedure, was developed to address the complications that are associated with the Modified Seldinger Approach. The method is performed in the operating room under conscious sedation, a type of sedation that feels similar to a dream state. The procedure involves an overnight stay in the hospital. During the procedure, your surgeon will create skin flaps on your neck, exposing the inside of your trachea. The skin flaps will be tacked on to the underlying muscles of your neck, which will create a permanent pathway inside the trachea. With this procedure, transtracheal oxygen can begin the following day, instead of in a week, as in the Seldinger technique.
What About Standard Oxygen Therapy?Standard oxygen therapy via a nasal cannula remains part of the standard of care for treatment of COPD. Studies have shown that continuous, long-term oxygen therapy improves survival in COPD patients, increases exercise tolerance, enhances neuropsychologic function, reduces excessive red blood cell production, decreases pulmonary hypertension, and reduces hospitalizations. To learn more about the benefits of oxygen therapy in COPD, read The Facts About Oxygen Therapy.
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