Abstract
Objective
To evaluate the efficiency of a new device developed to remove obstructions from endotracheal tubes (ETT) in mechanically ventilated patients.
Design
Open study in mechanically ventilated sedated and paralyzed ICU patients.
Setting
General ICU and Laboratory of Respiratory Mechanics of the University of Rome “La Sapienza”.
Patients
8 consecutive unselected mechanically ventilated, critically ill patients in which a partial obstruction of ETT was suspected on the basis of an increase of the peak inspiratory pressure (>20%) plus the difficult introduction of a standard suction catheter.
Interventions
Obstructions to ETT were removed with an experimental “obstruction remover” (OR)
Measurements
“In vivo” ETT airflow resistance (0.25; 0.5; 0.75; 1l/s) was evaluated before and after use of the OR; the work of breathing necessary to overcome ETT resistance (WOBett) was also evaluated before and after OR use.
Results
The use of OR significantly reduced in all patients the ETT “in vivo” resistance (From 5.5±2.3 to 2.9±0.5 cmH2O/l/s at 0.25l/s,p<0.05; from 9±2.4 to 3.8±0.8 cmH2O/l/s at 0.51l/s; from 12.2±3.5 to 5.7±1.2 cmH2O/l/s at 0.75l/s; from 16.9±6 to 9.3±3.8 cmH2O/l/s at 1l/s,p<0.01 respectively). Also the WOBett was significantly reduced after use of the OR (from 0.66±0.19 to 0.34±0.08 J/l;p<0.05)
Conclusion
This experimental device can be safely and successfully used to remove obstructions from the ETT lumen, without suspending mechanical ventilation, reducing the need for rapid ETT substitution in emergency and life-threatening situations.
Article PDF
References
Zwillich CW, Pierson DJ, Creagh CE (1974) Complications of assisted ventilation: a prospective study. Am J Med 57:161–165
Heat and Moisture Exchangers (1983) Health devices. Emerg Care Res Inst 121:155–158
Cohen IL, Weiberg PF, Fein A, Rowinski GS (1988) Endotracheal tube occlusion associated with the use of heat and moisture exchangers in the intensive care unit. Crit Care Med 16:277–279
De Blasi RA, Conti G, Bufi M, Gasparetto A (1992) A fibre optics system for the evaluation of airway pressure in mechanically ventilated patients. Intensive Care Med 18:405–409
Marini JJ, Rodriguez MR, Lamb V (1986) Bedside estimation of the inspiratory work of breathing during mechanical ventilation. Chest 89:56–63
Marini JJ (1991) Assessment of the breathing workload during mechanical ventilation. In: Pulmonary function in mechanically ventilated patients. Springer, Berlin, pp 62–80
Cinnella G, Villafane MC, Brochard L (1989) Evolution “in vivo” de la resistance et du diametre des sondes d'intubation. Reanim Soins Intensifs Med Urg 5:A459
Banner M, Blanch PB, Kirby R (1993) Imposed work of breathing and methods of triggering a demand flow, continuous positive airways pressure system. Crit Care Med 21:183–190
Lofaso F, Louis B, Brochard L, Harf A, Isabey D (1992) Use of the Blasius resistance formula to estimate the effective diameter of endotracheal tubes. Am Rev Respir Dis 146:974–979
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Conti, G., Rocco, M., De Blasi, R.A. et al. A new device to remove obstruction from endotracheal tubes during mechanical ventilation in critically ill patients. Intensive Care Med 20, 573–576 (1994). https://doi.org/10.1007/BF01705724
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01705724