Sir,We thank Dr. Grocott for the insightful comments regarding our frugal innovation of jet insufflator for cannot intubate cannot ventilate situation.[1] Dr. Grocott suggests that the new commercially available device, the Ventrain® (Ventinova Medical B. V., Eindhoven, The Netherlands) exploits the Hagen–Poiseuille law for both jet inspiration as well as active expiration. The Hagen–Poiseuille law comments on the flow characteristics of a fluid or gas. The active expiration occurring in Ventrain is according to Bernoulli's theorem.[2] Our device provides the possibility of expiration as a passive process, which is not available with jet ventilators like Manujet III.The availability of devices such as Ventrain, Rapid O2, Enk oxygen flow modulator and Manujet III is still limited in India.In a developing country like India where many anaesthesiologists work in low-resource settings, procuring such kind of equipment is difficult. Although the Ventrain® has withstood the evaluations of medical equipment regulatory agencies, the evidence supporting its safety is still limited. We have devised the equipment from existing resources without any major additional cost. We are aware of the need to conduct prospective studies to provide evidence for the use of our device. Cautious use of our equipment in 'cannot intubate cannot ventilate' situation may add to safety till sophisticated and cost-effective devices for such situations are made freely available in remote areas.
Authors: Michiel W P de Wolf; Reiner Gottschall; Niels P Preussler; Markus Paxian; Dietmar Enk Journal: Can J Anaesth Date: 2016-10-28 Impact factor: 5.063