Introduction

SCOOP transtracheal oxygen therapy must be viewed as a complete program of care, which is easy and highly successful when followed properly. We recommend that the physician who offers TTOT therapy start with predictably easy candidates.  This will promote initial success for the entire team and offer a smooth transition from novice to expert.   Our knowledge, gained from thousands of patient months, has shown that experience from the first 10 patients should be viewed as a learning curve, after which you will reduce morbidity and time commitments to this program.

General Indications

Patients must meet Medicare (NOTT) criteria for continuous oxygen therapy (i.e. PO₂ less than 55 mm Hg on room air), and HCFA criteria for long term oxygen therapy

Specific Indications

1. Currently using 1-4 liters per minute via nasal prongs
2. Have FEV₁'s between 500 and 1000 cc's
3. Have PO₂'s on supplemental oxygen greater than 55 mm Hg
4. Have PCO₂'s on supplemental oxygen less than 45 mm Hg
5. Live less than 1 hour from their physician
6. Have dependable transportation
7. Have strong significant other support
8. Spend less than 12 hours per day in bed
9. Leave the house routinely for activities such as shopping, socializing or work
10. Be highly motivated to improve their quality of life
11. Experience non-compliance related to the nasal cannula
12. Have need or desire for improved mobility
13. Experience complications of the nasal cannula that make the patient non-compliant with their O₂ therapy
14. Have cor pulmonale or erythrocythemia on nasal oxygen
15. Have hypoxemia that is refractory to nasal cannula or mask therapy
16. Patient Preference

Contraindications

1. Severe anxiety neurosis
2. Mental or physical incompetence
3. Upper airway obstruction
4. Pleura herniated over puncture site
5. Vocal cord paralysis
6. Acute respiratory failure

Precautions

Experience has proven that patients with one or more of the following precautions may have successful TTO₂ experiences once the learning curve has been established.

1. Refractory to nasal prong or mask oxygen therapy, i.e. PO₂ of less than 55 mm Hg at a flow rate of 6-8 liters per minute. This is a very difficult group of patients to treat with transtracheal oxygen and should not be attempted until sufficient experience with easier patients is acquired
2. Poor mechanical reserve (e.g. FEV1 less than 500 ml)
3. Hypercapnia without acidemia (e.g. PaCO₂ greater than 45 mm Hg)
4. End-stage in their disease process, with significantly elevated PCO₂ and/or profound hypoxemia despite supplemental oxygen
5. Display symptoms of severe disabling anxiety
6. Have very serious arrhythmia or other significant medical problems, i.e. insulin dependent diabetes
7. Bronchial hyperreactivity
8. Copious or viscous sputum
9. Bleeding disorder
10. Fat neck or other anatomic abnormality
11. Mild to moderate anxiety neurosis
12. Live alone or so far away from the transtracheal support unit that they can not be adequately monitored