Objective: To evaluate the effects of tracheal gas insufflation (TGI) on blood gases exchange (especially paCO2) in children with severe respiratory failure. Study design: Prospective observational study. Setting: Department of Anesthesiology and Intensive Care ECMO Center; University Children’s Hospital, Brno. Patients: 8 children with acute hypoxemic respiratory failure with pronounced hypercapnia. Methods: Patients were mechanically ventilated in PCV or PRVC mode; oxygenation was optimalized with increase of mean airway pressure (Paw) by increasing PEEP with limited peak airway pressure (PIP) with respect to the lowest possible FiO2. Tidal volumes were < 10 ml/kg, minute ventilation was increased by increasing respiratory rate (RR). If there were reached values of paCO2 > 10.0 kPa and/or pH < 7.2, tracheal gas insufflation was instituted, with catheter gas flow from 150 to 200 ml/kg/min. We monitored the values of pH, paO2, p aCO2, p aO2/FiO2, oxygenation index and ventilation index. Paired t-test was used to compare mean parameters obtained at time 0 and after 3 hours of TGI. Results: After 3 hours of TGI, pH increased from 7.25 to 7.42 (p = 0.0002), paCO2 decreased from 10.58 to 4.79 kPa (p<0.0001) and ventilation index decreased from 76.3 to 33.9 (p<0.0002). The changes in paO2, paO2/FiO2, OI are not statistically significant. Conclusion: TGI effectively eliminates CO2, improves alveolar ventilation and does not affect oxygenation. It is a suitable therapeutic supplement to conventional mechanical ventilation of patients with severe respiratory failure with hypercapnia.

        Key words: tracheal gas insufflation – respiratory failure – CO2 elimination – children