What is Transtracheal Oxygen Therapy for COPD?

The trachea brings air to the lungs.
The trachea brings air to the lungs. SEBASTIAN KAULITZKI/Getty Images

Question: What is transtracheal oxygen therapy for COPD?

Answer: Most people with COPD who are on oxygen therapy get their oxygen through a tube in their nose. Transtracheal oxygen therapy, or TTOT, is another way to provide oxygen to COPD patients. As you might guess from the name, transtracheal oxygen therapy provides the oxygen directly into your trachea, or windpipe, through a small plastic tube called a catheter.

Why Don't More People Know About TTOT?

Even though it's been around for more than three decades, transtracheal oxygen therapy honestly isn't used all that much. It's usually reserved for patients who have a low blood level of oxygen that has not been successfully treated with a nasal cannula, the usual way of providing oxygen in COPD.

While advocates of the procedure strongly believe that transtracheal oxygen therapy has a place as a safe and effective approach to oxygen therapy in COPD, there are reasons why it isn't more common.

First, it's invasive (you need to have a catheter inserted into your windpipe). Second, there are potentially serious complications associated with it, including frequent plugging of the tube going into your windpipe.

That's why at present, transtracheal oxygen therapy is not considered part of the standard of care for COPD treatment.

How is the Procedure Performed?

There are two main approaches to preparing someone for transtracheal oxygen therapy.

The Modified Seldinger Approach is the best-known procedure, although it's declining in popularity because insurance companies don't pay well for it, the procedure itself is quite laborious, and it generally involves more complications than newer methods. The procedure is performed under local anesthesia on an outpatient basis.

A small incision is made into the neck, and a needle is passed through the incision and into the trachea. A wire guide is then passed through the needle, and the needle itself is removed.

A smooth tube called a dilator then 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 the stent has been placed properly. 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.

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 itself 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 your brain 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.

Sources:

J.Adamo MD, A.Mehta MD, K.Stelmach RN RRT, D.Meeker MD, T.Rice MD, & J.Stoller MD. The Cleveland Clinic's Initial Experience with Transtracheal Oxygen Therapy. Respiratory Care, February, 1990. Vol 35 No 2.

K.Christopher, MD; B.Spofford, MD; P.Brannin, MSN; T.Petty, MD. Transtracheal Oxygen Therapy for Refractory Hypoxemia. JAMA. July 25, 1986. Vol 256. No 4.

J.Goodman, BS, RRT. Transtracheal Oxygen Therapy: The Best-Kept Secret in Medicine? RT: For Decision Makers in Respiratory Care. August, 2008.

Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Intern Med. 1980 Sep;93(3):391-8.

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