Efficacy of a self-made tracheostomy oxygen delivery device for oxygen therapy during postoperative anesthesia recovery

Abstract

BACKGROUND:

Patients with tracheotomy are often monitored in the anesthesia recovery room after reoperation. During this period, oxygen therapy is necessary, and the existing tracheostomy oxygen supply device has many defects.

OBJECTIVE:

To evaluate the efficacy of a self-made tracheostomy oxygen delivery device on oxygen therapy during postoperative anesthesia recovery.

METHODS:

Patients were randomly divided into two groups, E and C, with 30 patients in each group, and admitted to the post-anesthesia care unit (PACU). Patients in group E received oxygen through a self-made tracheostomy oxygen delivery device, while patients in group C were supplied oxygen through a unilateral nasal cannula. Respiration (R), pulse oximetry (SpO₂), and the number of patients on ventilators were recorded at the time of admission (T₀) and one hour after admission (T₁). Rapid dry blood gas analyses were performed on 0.6 ml samples of arterial blood collected at T₀ and T₁.

RESULTS:

Compared to group C, patients in group E had significantly higher arterial partial pressure of oxygen (PaO₂), arterial oxygen saturation (SaO₂), total carbon dioxide (T-CO₂), and actual bicarbonate (AB), while arterial partial pressure of carbon dioxide (PaCO₂) was significantly reduced ( $P<$ 0.01 or $<$ 0.05). Compared to T₀, PaO₂ decreased in both groups at T₁, PaCO₂ decreased in group E, while SaO₂, T-CO₂, and AB decreased in group C ( $P<$ 0.01 or $<$ 0.05).

CONCLUSION:

We found that using the self-made tracheostomy oxygen delivery device in postoperative anesthesia recovery had advantages such as a secure connection to the tracheostoma, adjustable oxygen concentration, air filtration, and the ability to switch oxygen supply between the ventilator and humidifier.

Keywords

Anesthesia recovery general anesthesia oxygen delivery device oxygen therapy self-made tracheostomy

1. Introduction

A tracheotomy is an emergency procedure to rescue critically ill patients or improve ventilation before laryngeal surgery [1, 2, 3]. After the procedure, patients often require the placement of long-term metal kits or disposable tracheal cannulas [4]. Post-tracheotomy, most patients are closely monitored and managed in the intensive care unit (ICU) or the post-anesthesia care unit (PACU) until relevant physiological parameters stabilize, after which they are transferred to standard care units [5]. Oxygen therapy is vital during this postoperative period. However, conventional tracheostomy oxygen delivery devices have several drawbacks, including a large interface with the skin of the neck, suboptimal sealing performance of the tracheostomy kit, a lack of adjustable oxygen concentration on demand, and the inability to seamlessly switch oxygen supply between the ventilator and humidifier (Table 1) [6]. At present, there is no latest technology about self-made tracheostomy oxygen supply equipment. In order to improve the oxygen supply conditions of such patients and overcome the above defects of the current tracheostomy oxygen supply equipment, it is necessary to develop a new oxygen supply equipment to provide oxygen for patients with tracheostomy in the recovery period of anesthesia. Consequently, we manufactured a tracheostomy oxygen delivery device for oxygen therapy during postoperative anesthesia recovery. The clinical outcomes following the use of this self-made device are reported in the sections that follow.

Table 1
Comparison of different tracheotomy oxygen delivery devices

Indicators	Self-made tracheostomy oxygen delivery device	Conventional tracheostomy oxygen delivery devices
Sealing performance	Good	Bad
Contact area with neck skin	Small	Large
Adjust oxygen concentration	Able	Unable
Connect humidifier for oxygen supply	Able	Able
Connect the anesthesia machine for oxygen supply	Able	Unable

2. Materials and methods

2.1 General information

This study was approved by the Medical Ethics Committee of the Sichuan Provincial Bayi Rehabilitation Center (Approval No. CKLL-BY2021003), with all participants giving their signed informed consent. The sample included 60 patients who underwent surgery and also had a tracheostomy procedure done at the Sichuan Provincial Bayi Rehabilitation Center between January 2022 and December 2023. There were 38 male and 22 female patients, aged 19–64 years, with a body mass index (BMI) ranging between 21.0–32.5 kg/m². The surgeries that were performed included 28 cases of cranial repair, 14 cases of ventriculo-peritoneal shunt, 10 cases of transurethral ureteral or bladder lithotripsy, and 8 cases of laparoscopic cholecystectomy. All patients were transferred to the PACU postoperatively.

The inclusion criteria were as follows: (1) patients who were in a persistent vegetative state (PVS) or minimally conscious state (MCS); (2) those who had undergone a preoperative tracheostomy; and (3) their health status grading was American Society of Anesthesiologists (ASA) grade IV.

The exclusion criteria were as follows: (1) patients who had a fever or lung infection in the last two weeks; (2) patients postoperatively transferred to the ICU or general ward; and (3) patients whose SpO₂ was $\leqslant$ 92% when admitted to the PACU.

The enrolled patients were randomly divided into the following two groups: the self-made tracheostomy oxygen delivery device group (group E) and the unilateral nasal cannula group (group C), with 30 cases in each group.

There was no statistically significant difference in gender, age, BMI, or type of surgery between groups E and C ( $P>$ 0.05) (Table 2).

Table 2
Comparison of general information between the two groups ( $n=$ 30)

Group	$n$	Gender (M/F, $n$ )	Age ( $\bar{x}\pm s$ , y)	BMI ( $\bar{x}\pm s$ kg/m²)	Type of surgery ( $n$ )
					Cranial repair	Ventriculo- peritoneal shunt	Transurethral lithotripsy	Laparoscopic cholecystectomy
Group E	30	21/9	44 $\pm$ 15	23.4 $\pm$ 1.7	15	6	6	3
Group C	30	17/13	40 $\pm$ 14	24.2 $\pm$ 1.9	13	8	4	5
$t$	–	–	1.215	1.671	–	–	–	–
$P$	–	0.422^∗	0.229	0.100	0.796^∗	0.761^∗	0.731^∗	0.706^∗

Note: ^∗ Fisher’s Exact Test; R: Respiration, BMI: Body mass index.

2.2 Methods

Upon the patient’s admission to the operation room, electrocardiography, blood pressure, pulse oximetry (SpO₂), and bispectral index (BIS) were monitored. A quantity of 0.3 mg of pentylenetetrazol hydrochloride was administered intravenously. Radial artery catheterization was done to enable measuring pressure under regional anesthesia.

Anesthesia induction was standardized across both groups, as detailed below: Initially, patients received 0.03 mg/kg of midazolam intravenously, followed by 0.3 $\mu$ g/kg of sufentanil intravenously and 0.3 mg/kg of remazolam intravenously for anesthesia induction. Subsequently, the endotracheal tube was replaced via tracheostomy, maintaining an intubation depth of 8 cm from the tracheostoma. The anesthesia machine was then connected for mechanical ventilation, delivering a tidal volume of 6–8 ml/kg, a respiratory frequency of 12 breaths/min, and an I:E (inspiration-to-expiration) ratio of 1:2. Post-endotracheal tube change, intravenous administration of 0.15 ml/kg of cisatracurium, 0.1–0.2 $\mu$ g/kg/min of remifentanil, and 2% sevoflurane (inhalation) was used for maintenance of anesthesia.

Upon completion of the surgery, anesthesia drugs were discontinued. Subsequently, 1 mg of neostigmine and 0.5 mg of atropine were administered intravenously to counteract residual muscular relaxation following spontaneous respiration recovery. Tracheotomy tube replacement was then performed, and patients were transferred to the PACU for continuous monitoring of their electrocardiogram, blood pressure, and SpO₂. Oxygen supplementation was provided via either the self-made tracheostomy oxygen delivery device (utilizing the small-diameter ventilation end) in group E or the unilateral nasal cannula via the tracheostoma in group C, with an oxygen flow rate of 2 L/min maintained in both groups. In cases where the SpO₂ remained below 92% for 3 minutes, oxygen supplementation was done either through the self-made tracheostomy oxygen delivery device (utilizing the large-diameter vent) connected to the ventilator in group E or directly via the ventilator in group C.

2.3 Observational indexes

The R, SpO₂, and number of patients on ventilators were recorded at two time points: T₀ and T₁. Rapid dry blood gas analyses were conducted using 0.6 ml of arterial blood collected at T₀ and T₁ utilizing the i15 biochemical blood gas analyzer, Edan Instruments, Inc., Shenzhen.

2.4 Statistical analysis

Analysis was performed using SPSS 25.0 statistical software. Quantitative data were expressed as the mean $\pm$ standard deviation ( $\bar{x}\pm s$ ). The between-groups $t$ -test was used for comparison between two groups, while the paired $t$ -test was used for comparison within groups. Categorical data were expressed as cases (%), and the Fisher’s exact test was used for comparison. Statistical significance was fixed at a $P$ value of $<$ 0.05.

3. Results

3.1 Process of manufacturing the tracheostomy oxygen delivery device

The tracheostomy oxygen delivery device consists of an inlet pipe, a reservoir bag, and an outlet pipe, which are interconnected. In order to enable seamless switching of oxygen supply between the ventilator and humidifier, the large-diameter vent connection of the inlet pipe is connected to the ventilator pipeline, or the small-diameter vent connection is connected to the connection pipe of the humidifier bottle. Additionally, the cone-shaped outlet pipe is attached to the tracheostomy kit. The inlet pipe and outlet pipe are connected through the reservoir bag, which is equipped with an air control valve and a filter layer (Patent No.CN2020201390782 and No.CN202020300432887) [7, 8] (Figs 1 and 2).

Figure 1.

Diagram of the self-made tracheostoma oxygen delivery device. Note: 1: Inlet pipe, 11: Large-diameter vent connection, 12: Small-diameter vent connection, 13: Large-diameter cap, 14: Small-diameter cap, 15: Vent pipe, 2: Reservoir bag, 3: Outlet pipe, 31: Outlet cone-shaped pipe, 32: Outlet thread hose.

Figure 2.

Diagram of the reservoir bag and air control valve. Note: 2: Reservoir bag, 21: Air control valve, 211: Rotatable shutter, 2111: Adjusting orifice, 2112: Adjusting knob, 212: Hole layer, 213: Filter layer.

3.2 Comparison of R, SpO₂, and ventilator use at T₀ and T₁ between the two groups

The two groups did not differ significantly with respect to R, SpO₂, and the number of patients on ventilator at T₀ and T₁ ( $P>$ 0.05) (Table 3).

Table 3
Comparison of R, SpO2, and ventilator use at T0 and T1 between the two groups ( $n=$ 30)

Group	$n$	R ( $\bar{x}\pm s$ , breaths/min)		SPO₂ (%)		Ventilator use [ $n$ (%)]
		T₀	T₁	T₀	T₁
Group E	30	18.53 $\pm$ 2.06	20.20 $\pm$ 1.06	96.30 $\pm$ 2.68	97.20 $\pm$ 2.43	1 (3.33)
Group C	30	18.10 $\pm$ 2.34	19.77 $\pm$ 1.25	95.40 $\pm$ 3.08	97.23 $\pm$ 1.77	4 (13.33)
$t$		0.764	1.393	1.207	0.061	–
$P$		0.448	0.169	0.232	0.952	0.353^∗

Note: ^∗ Fisher’s Exact Test; R: Respiration, SpO₂: Pulse oximetry.

3.3 Comparison of blood gas analysis parameters at T₀ and T₁ between the two groups

The levels of PaO₂, SaO₂, T-CO₂, and AB increased while PaCO₂ decreased at T₁ in group E compared to group C, with the difference being statistically significant ( $P<$ 0.01 or $<$ 0.05). Furthermore, when comparing T₁ to T₀ within each group, there was a reduction in PaO₂ in both groups at T₁, and PaCO₂ decreased in group E, while SaO₂, T-CO₂, and AB declined in group C ( $P<$ 0.01 or $<$ 0.05) (Table 4).

4. Discussion

The tracheostomy oxygen delivery device used in this study is produced by Henan Tuoren Medical Equipment Group Co., Ltd, China. The silicone or plastic materials used comply with the relevant standards of GB/T16483-2008 and regulations, including biocompatibility, chemical stability, physical properties, antibacterial properties, toxicological information, ethylene oxide sterilization, disposable use, and disposal of medical waste after use, to ensure that there are no adverse effects on the health of patients.

In the case screening of this study, the surgical categories include cranial repair, ventriculoperitoneal shunt, transurethral ureteral or bladder lithotripsy, and laparoscopic cholecystectomy. Although the types of operations are different, they all have a common feature, that is, tracheostomy has been performed before the operation, and the operations are carried out under general anesthesia. After the operation, tracheal cannula is replaced and oxygen is given through tracheostomy, which ensures the correlation between the research and study outcomes.

In a previous study [9], we developed a PACU transfer-out assessment scale specifically designed for patients in PVS or MCS. This scale underwent rigorous reliability and validity testing. The Respiration, Circulation, Oxygenation, Bispectral index, and muscle relaxation scale (RCOBN scale) was used for the evaluation of postoperative PACU transfer-out readiness for such patients. As per the norms of this scale, only patients achieving a total score of eight points are deemed eligible for being transferred out of the PACU. Oxygenation is an important patient evaluation index. However, achieving consistent alignment between oxygen supply devices and tracheostomy kits poses a challenge with existing oxygen delivery devices. Hence, we developed a tracheostomy oxygen delivery device tailored for oxygen therapy during the postoperative anesthesia recovery in this patient population.

As seen in this study, the baseline measurements of R, SpO₂, and blood gas indexes were generally comparable between the two groups, E and C, at T₀, as was the number of patients on ventilators. After 1 hour of oxygen supply through different apparatuses, there was no evident change in the values of R and SpO₂ in either group, and blood gas indexes also remained within the normal range. However, at time point T1, the levels of PaO₂, SaO₂, T-CO₂, and AB in group E were elevated, while PaCO₂ declined when compared with group C. Furthermore, when compared to baseline values within each group, PaO₂

Table 4
Comparison of blood gas analysis parameters at T0 and T1 between the two groups ( $\bar{x}\pm s$ , $n=$ 30)

Group	$n$	pH		PaO2 (mmHg)		SaO2 (%)		PaCO2 (mmHg)		T-CO2 (mmHg)		SB (mmol/L)		AB (mmol/L)
		T0	T1	T0	T1	T0	T1	T0	T1	T0	T1	T0	T1	T0	T1
Group E	30	7.41 $\pm$ 0.08	7.41 $\pm$ 0.04	421.03 $\pm$ 94.63	132.70 $\pm$ 28.39^a	99.83 $\pm$ 0.38	99.37 $\pm$ 0.89	42.33 $\pm$ 3.54	40.51 $\pm$ 2.84^a	29.77 $\pm$ 2.62	29.99 $\pm$ 2.25	24.18 $\pm$ 1.95	24.31 $\pm$ 1.67	24.58 $\pm$ 1.90	24.28 $\pm$ 1.47
Group C	30	7.39 $\pm$ 0.06	7.39 $\pm$ 0.04	399.90 $\pm$ 88.21	112.93 $\pm$ 23.65^a	99.87 $\pm$ 0.35	98.33 $\pm$ 1.45^a	41.90 $\pm$ 3.68	42.80 $\pm$ 3.24	28.97 $\pm$ 3.02	27.73 $\pm$ 3.15^a	24.41 $\pm$ 1.99	24.8 $\pm$ 1.81	24.64 $\pm$ 1.96	23.22 $\pm$ 1.64^b
$t$		1.253	1.579	0.895	2.930	0.356	3.333	0.458	2.911	1.095	3.192	0.528	0.385	0.121	2.640
$P$		0.215	0.120	0.375	0.005	0.723	0.002	0.648	0.005	0.278	0.002	0.600	0.702	0.904	0.011

Note: Compare with T0, ^aP < 0.01, ^bP < 0.05; PH: Pondus Hydrogenii, PaO2: Arterial partial pressure of oxygen, SaO2: Arterial oxygen saturation, PaCO2: Arterial partial pressure of carbon dioxide, T-CO2: Total carbon dioxide, SB: Standard bicarbonate, AB: Actual bicarbonate.

decreased in both groups at T₁, PaCO₂ decreased in group E, while SaO₂, T-CO₂, and AB decreased in group C at T₁.

The traditional unilateral nasal cannula placed at the tracheostoma is an open type of oxygen supply. Despite providing constant oxygen flow, achieving an optimal oxygen concentration remains challenging in this modality due to the mixing of oxygen with ambient air at the tracheostoma [10]. Additionally, the prolonged use of disposable tracheotomy cannulas with cuffs has been associated with complications such as adhesion of the endotracheal wall and cuff, as well as granulation formation, leading to difficulties in extubation and the need for reoperation [11, 12]. While metal catheters are often used to mitigate these issues, the orifice not aligning with the respiratory circuit port hinders effective oxygen supply from the ventilator.

However, the self-made tracheostomy oxygen delivery device addresses these challenges by enabling switchable oxygen supply between the ventilator and humidifier as needed through the connection between the inlet pipe of the oxygen delivery device and the pipeline of the humidifier or ventilator. Furthermore, it facilitates compatibility with various tracheostoma catheters, thereby overcoming issues associated with cuff adhesion and granulation formation. Moreover, the device resolves the problem of a large interface between the oxygen mask and the skin of the neck by connecting the cone-shaped outlet pipe of the oxygen delivery device with the tracheostoma catheter. In addition, an air control valve and filter layer are integrated above the reservoir bag. The former allows for adjustment of the concentration of inhaled oxygen and exhaled carbon dioxide, while the latter functions similar to an artificial nose to filter out airborne dust, thus aligning with hospital infection management requirements.

As a consequence of machine-controlled respiration during surgery and the administration of high oxygen concentrations during anesthesia, the levels of PaO₂ at T₁ were observed to be lower than those at T₀ in both groups, despite similar pH values within the normal range. Oxygen was delivered via the self-made tracheostomy oxygen delivery device for patients in Group E, which effectively mitigated air dilution through its air control valve, resulting in increased effective oxygen concentration. This led to an increase in PaO₂ and SaO₂ in group E, along with a decline in PaCO₂ at T1 when compared with group C. Influenced by both respiration and metabolism in vivo [13], T-CO₂ reflects the sum of blood carbon dioxide (CO₂) and bicarbonate (HCO3^ï¼). In cases of metabolic acidosis, it decreases significantly, while in cases of alkalosis, it increases significantly [14]. Therefore, in group E, T-CO₂ increased as PaCO₂ decreased. Additionally, reflecting the actual content of HCO₃ ^ï¼, there was an increase in AB levels at T₁ due to the respiratory influence.

It is important to note that although there were differences in the blood gas values of the two groups at T₁, no significant differences were observed with respect to R or SpO₂. According to the oxygen dissociation curve [15], when PaO₂ is $>$ 100 mmHg, the curve is situated in the upper segment, resulting in limited effects of PaO₂ alterations on SpO₂ and thus minimal differences between the two groups. However, it is worth mentioning that the potential effects of decreased PaO₂ and increased PaCO₂ on regional tissue oxygen saturation (rStO₂) in group C were not investigated in this study, representing a limitation. Further research, with a larger sample size and thorough safety considerations, is warranted. The absence of inhaled oxygen concentration monitoring underscores the necessity of a 15-minute period of deoxygenation for patients in group E before their transfer from the PACU to the general ward to allow for stabilization of SpO₂ levels. This procedural measure is crucial to ensuring patient safety and optimal postoperative care. In addition, in order to make the study universal, it can be carried out in different populations in future studies, and further study whether the self-made tracheostomy oxygen delivery device can control the biofilm formation and local infection caused by tracheostomy.

5. Conclusion

In conclusion, the utilization of the self-made tracheostomy oxygen delivery device for oxygen supply in anesthesia recovery holds significant potential in clinical settings. This device is composed of an input pipe, an air storage bag and an output pipe, wherein the input pipe can be connected with the ventilator pipe or the humidification bottle connecting pipe, the output pipe is connected with the tracheostomy kit, and the air regulating valve and a filter layer are set on the air storage bag. This device was found to offer several advantages, including a secure connection to the tracheostoma, the ability to adjust oxygen concentration, air filtration capabilities, and the option for switchable oxygen supply between the ventilator and humidifier. This is more conducive to improving oxygenation, and these features collectively contribute to enhanced patient care and recovery outcomes, highlighting the suitability of the device for widespread clinical use and promotion.

Funding

Health Commission of Sichuan Provincial (No.: 19PJ255).

Ethics approval and consent to participate

This study was conducted with approval from the Ethics Committee of Sichuan Provincial Rehabilitation Hospital (No. CKLL-BY2021003). This study was conducted in accordance with the declaration of Helsinki. Written informed consent was obtained from all participants.

Consent for publication

Not applicable.

Author contributions

Conception and design of the research: Yi-ying Xiong, Ze-yu Zhao.

Acquisition of data: Yi-ying Xiong, Chao-yang Chen, Xiang Li, Xin-xin Yue.

Analysis and interpretation of the data: Xiang Li, Xin-xin Yue.

Statistical analysis: Xin-xin Yue, Ze-yu Zhao.

Obtaining financing: Ze-yu Zhao.

Writing of the manuscript: Yi-ying Xiong, Chao-yang Chen.

Critical revision of the manuscript for intellectual content: Ze-yu Zhao.

All authors read and approved the final draft.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Footnotes

Acknowledgments

We would like to acknowledge the hard and dedicated work of all the staff who implemented the intervention and evaluation components of the study.

Conflict of interest

The authors declare that they have no competing interests.

References

Kanazawa

Kurata

Nagai

Inoue

Nozaki

Mori

Ishihara

Mori

Kumada

Shibata

Kato

Nakai

Kano

. Advantage of a higher position of the tracheostoma with glottic closure for preventing complications related to tracheostomy tube: A retrospective cohort study. BMC Surg. 2022 Feb 11; 22(1): 50. doi: 10.1186/s12893-022-01505-2. PMID: 35148723; PMCID: PMC8832853.

Thomas

Alonso

Wendel Garcia

Diem

Kemper

Weiss

Both

. Cuffed versus uncuffed tracheal tubes in a rabbit training model for establishing an emergency front-of-neck airway in infants: A prospective trial. Br J Anaesth. 2022 Feb; 128(2): 382-390. doi: 10.1016/j.bja.2021.11.017. Epub 2021 Dec 16. PMID: 34920855.

Jiang

Deng

Xiang

Tan

. Effects of respiratory training on ventilation potential and extubation time in patients with tracheotomy: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021 Nov 19; 100(46): e27704. doi: 10.1097/MD.0000000000027704. PMID: 34797295; PMCID: PMC8601331.

Mills

Michou

King

Bellamy

Siddle

Brennan

Bojke

. Evidence for above cuff vocalization in patients with a tracheostomy: A systematic review. Laryngoscope. 2022 Mar; 132(3): 600-611. doi: 10.1002/lary.29591. Epub 2021 May 1. PMID: 33932229.

Lei

Chen

, et al. Predictive value of stroke-related early tracheotomy score for tracheotomy in neurocritical patients. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021; 33(11): 1342-1346.

Huang

Liang

Huang

. Application of gas cutting mask atomizer in oxygen inhalation for tracheotomy patients. Lingnan Journal of Emergency Medicine. 2016; 21(2): 190-192.

Sichuan Bayi Rehabilitation Center (Sichuan rehabilitation hospital). A tracheostomy oxygen supply device: cn2020 20139078.2. 2020-11-24.

Sichuan Bayi Rehabilitation Center (Sichuan rehabilitation hospital). Oxygen supply device connector: cn202020300 43288.7. 2020-06-26.

Xiong

Zhang

, et al. Development and reliability and validity testing of the assessment scale for patients with persistent vegetative state or minimally conscious state discharge from the anesthesia recovery room. Chinese Journal of Practical Nursing. 2022; 38(9): 653-658.

10.

Twose

Thomas

Morgan

Broad

. Comparison of high-flow oxygen therapy with standard oxygen therapy for prevention of postoperative pulmonary complications after major head and neck surgery involving insertion of a tracheostomy: A feasibility study. Br J Oral Maxillofac Surg. 2019 Dec; 57(10): 1014-1018. doi: 10.1016/j.bjoms.2019.08.021. Epub 2019 Sep 9. PMID: 31515152.

11.

Wei

Qin

Chen

Feng

Wei

Tan

Liu

. Analysis of clinical characteristics of 617 patients with benign airway stenosis. Front Med (Lausanne). 2023 Jul 20; 10: 1202309. doi: 10.3389/fmed.2023.1202309. PMID: 37547601; PMCID: PMC10397385.

12.

Zhang

Chen

. Treatment of secondary benign airway stenosis after tracheotomy with Montgomery T-tube. Math Biosci Eng. 2019 Aug 27; 16(6): 7839-7849. doi: 10.3934/mbe.2019394. PMID: 31698643.

13.

Zhang

Glosson

Bascom

Rowson

Wang

Drackley

. Metabolic and blood acid-base responses to prepartum dietary cation-anion difference and calcium content in transition dairy cows. J Dairy Sci. 2022 Feb; 105(2): 1199-1210. doi: 10.3168/jds.2021-21191. Epub 2021 Dec 23. PMID: 34955266.

14.

Diaz-Garzon

Fernandez-Calle

Aarsand

Sandberg

Buno

. Biological variation of venous acid-base status measurands in athletes. Clin Chim Acta. 2021 Dec; 523: 497-503. doi: 10.1016/j.cca.2021.11.001. Epub 2021 Nov 5. PMID: 34748780.

15.

Shepherd

JRA

Dominelli

Roy

Secomb

Hoyer

Oliveira

Joyner

. Modelling the relationships between haemoglobin oxygen affinity and the oxygen cascade in humans. J Physiol. 2019 Aug; 597(16): 4193-4202. doi: 10.1113/JP277591. Epub 2019 Jul 25. PMID: 31290158; PMCID: PMC6697208.

Efficacy of a self-made tracheostomy oxygen delivery device for oxygen therapy during postoperative anesthesia recovery

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

Table 1 Comparison of different tracheotomy oxygen delivery devices

2.1 General information

Table 2 Comparison of general information between the two groups ( n = 30)

2.3 Observational indexes

2.4 Statistical analysis

3. Results

3.1 Process of manufacturing the tracheostomy oxygen delivery device

Table 3 Comparison of R, SpO2, and ventilator use at T0 and T1 between the two groups ( n = 30)

4. Discussion

Table 4 Comparison of blood gas analysis parameters at T0 and T1 between the two groups ( x ¯ ± s , n = 30)

Funding

Ethics approval and consent to participate

Consent for publication

Author contributions

Data availability

Footnotes

Acknowledgments

Conflict of interest

References

Table 1
Comparison of different tracheotomy oxygen delivery devices

Table 2
Comparison of general information between the two groups ( $n=$ 30)

Table 3
Comparison of R, SpO2, and ventilator use at T0 and T1 between the two groups ( $n=$ 30)

Table 4
Comparison of blood gas analysis parameters at T0 and T1 between the two groups ( $\bar{x}\pm s$ , $n=$ 30)