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Kelebeyev S, Davison W, Ford BL, Pitman MJ, Bulman WA. The Effects of Endotracheal Tube Size During Bronchoscopy in Simulated Models of Intubated Patients. Laryngoscope 2023; 133:147-153. [PMID: 35218022 DOI: 10.1002/lary.30074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/11/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim is to use a simulation lung model to assess the possibility of performing bronchoscopy through endotracheal tubes (ETT) less than 8.0-mm while appropriately ventilating patients with normal and ARDS lungs in the setting of SARS-CoV-2. METHODS Five SHERIDAN® ETTs were used to ventilate SimMan® 3G under respiratory compliance levels representing normal and severe ARDS lungs. Baseline measurements of peak pressure, plateau pressure, and auto-positive end expiratory pressure (auto-PEEP) were recorded at four different inspiratory times (Ti). Three different-sized disposable bronchoscopes were inserted, and all measurements were repeated. RESULTS Normal lung model: Slim bronchoscopes in 6.0-mm ETTs resulted in plateau pressures <30 cm H2 O, and increasing Ti to minimize peak pressure resulted in low auto-PEEP. Regular bronchoscopes in 7.0-mm ETTs had similar results. Large bronchoscopes in 7.5-mm ETTs generated plateau pressures ranging from 28 to 35 cm H2 O with modest auto-PEEP. Severe ARDS lung model: Slim bronchoscopes in 6.0-mm ETTs resulted in plateau pressures of 46 and an auto-PEEP of 5 cm H2 O. Regular bronchoscopes in 7.0-mm ETTs generated similar results. Large bronchoscopes in 8.0-mm ETTs displayed plateau pressures of 44 and an auto-PEEP of 2 cm H2 O. CONCLUSION To mitigate risk of laryngeal injury, larger ETTs during bronchoscopy should be avoided. Our data show bronchoscopy with any ETT causes auto-PEEP and high plateau pressures, especially in lungs with poor compliance; however, ETT less than 7.5 mm can be used when considering several factors. Our data also suggest similar studies in patients with varying degrees of ARDS would be informative. LEVEL OF EVIDENCE NA Laryngoscope, 133:147-153, 2023.
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Affiliation(s)
- Saveliy Kelebeyev
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Wesley Davison
- Department of Otolaryngology - Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irving Medical Center, New York, New York, USA
| | - Branden L Ford
- Mary & Michael Jaharis Simulation Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Michael J Pitman
- Department of Otolaryngology - Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irving Medical Center, New York, New York, USA
| | - William A Bulman
- Department of Medicine - Division of Pulmonary, Allergy and Critical Care, Columbia University Irving Medical Center, New York, New York, USA
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Arabi Y, Al Dorzi H, Ghanem A, Hegazy M, AlMatrood A, Alchin J, Mutairi M, Aqeil A. Humidification during mechanical ventilation to prevent endotracheal tube occlusion in critically ill patients: A case control study. Ann Thorac Med 2022; 17:37-43. [PMID: 35198047 PMCID: PMC8809127 DOI: 10.4103/atm.atm_135_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/25/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND: Endotracheal tube (ETT) occlusion is a potentially life-threatening event. This study describes a quality improvement project to prevent ETT occlusion in critically ill patients. METHODS: After a cluster of clinically significant ETT occlusion incidents at a tertiary-care intensive care unit (ICU), the root cause analysis suggested that the universal use of heat moisture exchangers (HMEs) was a major cause. Then, we prospectively audited new ETT occlusion incidents after changing our practices to evidence-based active and passive humidification during mechanical ventilation (MV). We also compared the outcomes of affected patients with matched controls. RESULTS: During 100 weeks, 18 incidents of clinically significant ETT occlusion occurred on a median of 7 days after intubation (interquartile range, 4.8–9.5): 8 in the 10 weeks before and 10 in the 90 weeks after changing humidification practices (8.1 vs. 1.0 incidents per 1000 ventilator days, respectively). The incidents were not suspected in 94.4%, the peak airway pressure was >30 cm H2O in only 25%, and 55.6% were being treated for pneumonia when ETT occlusion occurred. Compared with 51 matched controls, ETT occlusion cases had significantly longer MV duration (median of 13.5 vs. 4.0 days; P = 0.002) and ICU stay (median of 26.5 vs. 11.0 days; P = 0.006) and more tracheostomy (55.6% vs. 9.8%; P < 0.001). The hospital mortality was similar in cases and controls. CONCLUSIONS: The rate of ETT occlusion decreased after changing humidification practices from universal HME use to evidence-based active and passive humidification. ETT occlusion was associated with more tracheostomy and a longer duration of MV and ICU stay.
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Davies JD, Huang YC, MacIntyre NR. Evaluation of a novel endotracheal tube suctioning system incorporating an inflatable sweeper. ACTA ACUST UNITED AC 2021; 57:138-142. [PMID: 34734112 PMCID: PMC8509580 DOI: 10.29390/cjrt-2021-026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction Accumulation of secretions in an endotracheal tube can increase the resistance to flow resulting in an increased patient work of breathing when the patient is interacting with the ventilator. Retained secretions can also serve as an infection risk. Standard suction catheters are limited in their ability to keep the lumen of the endotracheal tube clear. A novel closed-suction catheter has been introduced that incorporates a balloon at its distal end that, when inflated, physically scrapes secretions out of the endotracheal tube (CleanSweep catheter (CSC), Teleflex, Morrisville NC). We hypothesized that the CSC would be more efficient at removing secretions from inside the endotracheal tube than a standard suction catheter (SSC). Methods We performed a bench study examining resistive pressures across different sizes of endotracheal tubes when cleaned by the CSC as compared with an SSC. This study was followed by a prospective crossover study again comparing the CSC with an SSC in intubated intensive care unit patients receiving mechanical ventilation and requiring frequent suctioning. Results For the bench study the CSC was significantly better in reducing airway resistive pressures (P < 0.001). In the prospective crossover study the CSC over 2 h also removed significantly more secretions than the SSC (P < 0.05). Conclusion Both our bench and crossover clinical study demonstrated improved clearance of secretions with the CSC vs an SSC. Further research is needed to ascertain the clinical outcome benefits of enhanced secretion removal.
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Affiliation(s)
- John D Davies
- Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Yuh Chin Huang
- Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Neil R MacIntyre
- Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
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Schönhofer B, Geiseler J, Dellweg D, Fuchs H, Moerer O, Weber-Carstens S, Westhoff M, Windisch W. Prolonged Weaning: S2k Guideline Published by the German Respiratory Society. Respiration 2020; 99:1-102. [PMID: 33302267 DOI: 10.1159/000510085] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 01/28/2023] Open
Abstract
Mechanical ventilation (MV) is an essential part of modern intensive care medicine. MV is performed in patients with severe respiratory failure caused by respiratory muscle insufficiency and/or lung parenchymal disease; that is, when other treatments such as medication, oxygen administration, secretion management, continuous positive airway pressure (CPAP), or nasal high-flow therapy have failed. MV is required for maintaining gas exchange and allows more time to curatively treat the underlying cause of respiratory failure. In the majority of ventilated patients, liberation or "weaning" from MV is routine, without the occurrence of any major problems. However, approximately 20% of patients require ongoing MV, despite amelioration of the conditions that precipitated the need for it in the first place. Approximately 40-50% of the time spent on MV is required to liberate the patient from the ventilator, a process called "weaning". In addition to acute respiratory failure, numerous factors can influence the duration and success rate of the weaning process; these include age, comorbidities, and conditions and complications acquired during the ICU stay. According to international consensus, "prolonged weaning" is defined as the weaning process in patients who have failed at least 3 weaning attempts, or require more than 7 days of weaning after the first spontaneous breathing trial (SBT). Given that prolonged weaning is a complex process, an interdisciplinary approach is essential for it to be successful. In specialised weaning centres, approximately 50% of patients with initial weaning failure can be liberated from MV after prolonged weaning. However, the heterogeneity of patients undergoing prolonged weaning precludes the direct comparison of individual centres. Patients with persistent weaning failure either die during the weaning process, or are discharged back to their home or to a long-term care facility with ongoing MV. Urged by the growing importance of prolonged weaning, this Sk2 Guideline was first published in 2014 as an initiative of the German Respiratory Society (DGP), in conjunction with other scientific societies involved in prolonged weaning. The emergence of new research, clinical study findings and registry data, as well as the accumulation of experience in daily practice, have made the revision of this guideline necessary. The following topics are dealt with in the present guideline: Definitions, epidemiology, weaning categories, underlying pathophysiology, prevention of prolonged weaning, treatment strategies in prolonged weaning, the weaning unit, discharge from hospital on MV, and recommendations for end-of-life decisions. Special emphasis was placed on the following themes: (1) A new classification of patient sub-groups in prolonged weaning. (2) Important aspects of pulmonary rehabilitation and neurorehabilitation in prolonged weaning. (3) Infrastructure and process organisation in the care of patients in prolonged weaning based on a continuous treatment concept. (4) Changes in therapeutic goals and communication with relatives. Aspects of paediatric weaning are addressed separately within individual chapters. The main aim of the revised guideline was to summarize both current evidence and expert-based knowledge on the topic of "prolonged weaning", and to use this information as a foundation for formulating recommendations related to "prolonged weaning", not only in acute medicine but also in the field of chronic intensive care medicine. The following professionals served as important addressees for this guideline: intensivists, pulmonary medicine specialists, anaesthesiologists, internists, cardiologists, surgeons, neurologists, paediatricians, geriatricians, palliative care clinicians, rehabilitation physicians, intensive/chronic care nurses, physiotherapists, respiratory therapists, speech therapists, medical service of health insurance, and associated ventilator manufacturers.
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Affiliation(s)
- Bernd Schönhofer
- Klinikum Agnes Karll Krankenhaus, Klinikum Region Hannover, Laatzen, Germany,
| | - Jens Geiseler
- Klinikum Vest, Medizinische Klinik IV: Pneumologie, Beatmungs- und Schlafmedizin, Marl, Germany
| | - Dominic Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie II, Schmallenberg, Germany
| | - Hans Fuchs
- Universitätsklinikum Freiburg, Zentrum für Kinder- und Jugendmedizin, Neonatologie und Pädiatrische Intensivmedizin, Freiburg, Germany
| | - Onnen Moerer
- Universitätsmedizin Göttingen, Klinik für Anästhesiologie, Göttingen, Germany
| | - Steffen Weber-Carstens
- Charité, Universitätsmedizin Berlin, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Virchow-Klinikum und Campus Mitte, Berlin, Germany
| | - Michael Westhoff
- Lungenklinik Hemer, Hemer, Germany
- Universität Witten/Herdecke, Herdecke, Germany
| | - Wolfram Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Universität Witten/Herdecke, Herdecke, Germany
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Ex Vivo Evaluation of Secretion-Clearing Device in Reducing Airway Resistance within Endotracheal Tubes. Crit Care Res Pract 2019; 2018:3258396. [PMID: 30652032 PMCID: PMC6311789 DOI: 10.1155/2018/3258396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/23/2018] [Accepted: 11/13/2018] [Indexed: 12/03/2022] Open
Abstract
Background Secretions accumulate in endotracheal tubes' (ETT) lumens upon their placement in patients. The secretions impact airway resistance and pressure. Secretions potentiate prolonged mechanical ventilation and ventilator-associated pneumonia. Our primary objective in this study was to evaluate an ETT-clearing device (ETT-CD) in its ability to remove secretions from ex vivo ETT lumens. Methods Forty ETTs, obtained from intensive care patients at extubation, were individually placed into a ventilator field performance testing simulator at 37°C. The pressure drop through the ETTs was measured at a flow rate of 60 L/min before and after cleaning with the ETT-CD and compared with unused, similarly sized controls tubes. The ETT-CD was inserted into an ETT until the tip reached Murphy's eye (hole in the side) of the ETT. The wiper, set back from the tip, was expanded by ETT-CD handle activation. As the ETT-CD was removed, the distal wiper extracted secretions from the ETT lumen. Results Forty ETTs were tested with nonparametric Wilcoxon signed-rank tests. Before being cleared with the ETT-CD, the median pressure drop in the extubated 7.5 mm ETTs was 17.8 cm H2O; after ETT-CD use, it was 12.3. The cleared ETTs were significantly improved over the ETTs before being cleared (p < 0.001); however, there remained a significant difference between the cleared ETTs and the control tubes (p=0.005), indicating the clearing was not to the level of an unused ETT. Similar results were determined for the 8.0 mm ETTs. Conclusions For the 7.5 mm and the 8.0 mm EETs, the ETT-CD improved effective patency of the ETTs over the uncleared ETTs, independent of occlusion location, tube size, or length of tube. However, there remained a significant difference between the cleared tubes and controls.
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6
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Adi NA, Tomer NT, Bergman GB, Kishinevsky EK, Wyncoll DW. Effects of Prolonged Mechanical Ventilation with a Closed Suction System on Endotracheal Tube Resistance and its Reversibility by a Closed Suction Cleaning System. Anaesth Intensive Care 2019; 41:728-35. [DOI: 10.1177/0310057x1304100607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- N. A. Adi
- Intensive Care Unit, Kaplan Medical Center, Rehovot, Israel
| | - N. T. Tomer
- Intensive Care Unit, Kaplan Medical Center, Rehovot, Israel
| | - G. B. Bergman
- Intensive Care Unit, Kaplan Medical Center, Rehovot, Israel
| | | | - D. W. Wyncoll
- Intensive Care Unit, Kaplan Medical Center, Rehovot, Israel
- Department of Intensive Care Medicine, Guy's and St Thomas NHS Foundation Trust, London, UK
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7
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Kenaley KM, Blackson T, Boylan L, Ciarlo J, Antunes M, Shaffer TH, Locke R. Impact of endotracheal tube biofilm and respiratory secretions on airway resistance and mechanics of breathing in a neonatal lung model. J Appl Physiol (1985) 2018; 125:1227-1231. [DOI: 10.1152/japplphysiol.00083.2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Endotracheal tube (ETT) obstruction from biofilm formation is a theoretical risk for intubated preterm neonates. The objective of this study is to determine the impact of ETT biofilm on ETT resistance and minute ventilation in a neonatal respiratory model. Postextubation 2.5- and 3.0-mm ETTs from ventilated preterm infants were matched with unused control ETTs. The pressure gradient across the ETT was measured at set flow rates and converted to airway resistance. Spontaneous breathing tests (SBTs) were performed using a virtual patient model and were considered “passed” if minute ventilation of patient ETTs was greater than 60% of control ETTs. Twenty-four 2.5-mm ETTs and sixteen 3.0-mm ETTs were analyzed. In both patient and control ETTs, as flow rate increases, the pressure gradient across the ETT also increases in a linear fashion. Resistance to flow in patient ETTs was statistically different from matched control ETTs ( P < 0.001), and patient ETTs had 19.9 cmH2O·l−1·sec−1 greater resistance than control ETTs. SBTs were performed in 27 of 40 ETTs. Twenty-six ETTs “passed” an SBT. In one obstructed 3.0-mm ETT, SBT measurements were unobtainable. The clinical impact of ETT biofilm as measured by a SBT appears to be minimal for the majority of patients in our study group. In 1 out of 27 ETTs, the presence of a biofilm significantly altered resistance to airflow and resulted in a failed SBT. Gas flow rate and ETT size had a greater impact on resistance to airflow and minute ventilation than ETT biofilm in this study sample. NEW & NOTEWORTHY This is the first study to our knowledge to characterize the impact of endotracheal tube (ETT) biofilm and respiratory secretions on resistance to airflow in a neonatal ETT using a simulation neonatal lung model. Results show that the clinical impact of ETT biofilm is minimal for the majority of patients in our study group, and ETT obstruction from biofilm is an uncommon cause of respiratory decompensation in a preterm neonate.
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Affiliation(s)
- Kaitlin M. Kenaley
- Pediatrics/Neonatology, Christiana Care Health System, Newark, Delaware
- Pediatrics/Neonatology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tom Blackson
- Pediatrics/Neonatology, Christiana Care Health System, Newark, Delaware
| | - Lori Boylan
- Pediatrics/Neonatology, Christiana Care Health System, Newark, Delaware
| | - Joseph Ciarlo
- Pediatrics/Neonatology, Christiana Care Health System, Newark, Delaware
| | - Michael Antunes
- Pediatrics/Neonatology, Christiana Care Health System, Newark, Delaware
| | - Thomas H. Shaffer
- Pediatrics/Neonatology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Alfred I. duPont Hospital for Children/Nemours, Wilmington, Delaware
| | - Robert Locke
- Pediatrics/Neonatology, Christiana Care Health System, Newark, Delaware
- Pediatrics/Neonatology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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8
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Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, Cook TM. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth 2017; 120:323-352. [PMID: 29406182 DOI: 10.1016/j.bja.2017.10.021] [Citation(s) in RCA: 449] [Impact Index Per Article: 64.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 12/17/2022] Open
Abstract
These guidelines describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations. They are a direct response to the 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society, which highlighted deficient management of these extremely vulnerable patients leading to major complications and avoidable deaths. They are founded on robust evidence where available, supplemented by expert consensus opinion where it is not. These guidelines recognize that improved outcomes of emergency airway management require closer attention to human factors, rather than simply introduction of new devices or improved technical proficiency. They stress the role of the airway team, a shared mental model, planning, and communication throughout airway management. The primacy of oxygenation including pre- and peroxygenation is emphasized. A modified rapid sequence approach is recommended. Optimal management is presented in an algorithm that combines Plans B and C, incorporating elements of the Vortex approach. To avoid delays and task fixation, the importance of limiting procedural attempts, promptly recognizing failure, and transitioning to the next algorithm step are emphasized. The guidelines recommend early use of a videolaryngoscope, with a screen visible to all, and second generation supraglottic airways for airway rescue. Recommendations for emergency front of neck airway are for a scalpel-bougie-tube technique while acknowledging the value of other techniques performed by trained experts. As most critical care airway catastrophes occur after intubation, from dislodged or blocked tubes, essential methods to avoid these complications are also emphasized.
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Affiliation(s)
- A Higgs
- Anaesthesia and Intensive Care Medicine, Warrington and Halton Hospitals NHS Foundation Trust, Cheshire, UK(8).
| | - B A McGrath
- Anaesthesia and Intensive Care Medicine, University Hospital South Manchester, Manchester, UK(9)
| | - C Goddard
- Anaesthesia & Intensive Care Medicine, Southport and Ormskirk Hospitals NHS Trust, Southport, UK(8)
| | - J Rangasami
- Anaesthesia & Intensive Care Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK(8)
| | - G Suntharalingam
- Intensive Care Medicine and Anaesthesia, London North West Healthcare NHS Trust, London, UK(10)
| | - R Gale
- Anaesthesia & Intensive Care Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK(11)
| | - T M Cook
- Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK(12)
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9
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Sound level analysis in endotracheal tube obstruction in spontaneous breathing and mechanical ventilation-an animal model study. J Clin Monit Comput 2016; 31:1235-1240. [PMID: 28025752 DOI: 10.1007/s10877-016-9973-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/18/2016] [Indexed: 10/20/2022]
Abstract
Endotracheal tube (ETT) obstruction, either complete or partial, is a serious life threatening complication in intubated patients. Therefore, implementing a practical method to diagnose this condition is vital. Alteration in respiratory sound signals caused by ETT occlusion can be used for early detection of obstruction. This study is aimed to assess changes in respiratory sound signals after creation of different types of tubal obstruction in an animal model experiment. Artificial internal obstructions were created in three different sizes and three different locations by stitching pieces of smaller tubes in ETTs with internal diameter of 8 mm. A microphone was used to record respiratory sounds during both spontaneous breathing and mechanical ventilation in seven anesthetized dogs. The sound intensity levels produced by different grades and degrees of obstructions were measured and compared with those in non-obstructed tubes. During spontaneous breathing, significant decrease in sound intensity level was detected even with the lowest grades of obstruction (p = 0.003, 0.001, and 0.002, proximal, middle and distal obstructions, respectively). However, in mechanical ventilation, significant decrease in sound intensity was observed only in distal tubal obstruction (p = 0.037). The difference among levels of sound intensity produced by different obstruction locations of occlusion was not statistically significant (p ≥ 0.090). Data analysis revealed that sound intensity level decreased significantly when the degree of obstruction increased. In addition, this change in sound level was not related to the location of obstruction. The decrease in sound intensity changes can be used to detect ETT obstruction. However, further studies are needed for clinical application.
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10
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Mann EE, Magin CM, Mettetal MR, May RM, Henry MM, DeLoid H, Prater J, Sullivan L, Thomas JG, Twite MD, Parker AE, Brennan AB, Reddy ST. Micropatterned Endotracheal Tubes Reduce Secretion-Related Lumen Occlusion. Ann Biomed Eng 2016; 44:3645-3654. [PMID: 27535564 DOI: 10.1007/s10439-016-1698-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/12/2016] [Indexed: 01/01/2023]
Abstract
Tracheal intubation disrupts physiological homeostasis of secretion production and clearance, resulting in secretion accumulation within endotracheal tubes (ETTs). Novel in vitro and in vivo models were developed to specifically recapitulate the clinical manifestations of ETT occlusion. The novel Sharklet™ micropatterned ETT was evaluated, using these models, for the ability to reduce the accumulation of both bacterial biofilm and airway mucus compared to a standard care ETT. Novel ETTs with micropattern on the inner and outer surfaces were placed adjacent to standard care ETTs in in vitro biofilm and airway patency (AP) models. The primary outcome for the biofilm model was to compare commercially-available ETTs (standard care and silver-coated) to micropatterned for quantity of biofilm accumulation. The AP model's primary outcome was to evaluate accumulation of artificial airway mucus. A 24-h ovine mechanical ventilation model evaluated the primary outcome of relative quantity of airway secretion accumulation in the ETTs tested. The secondary outcome was measuring the effect of secretion accumulation in the ETTs on airway resistance. Micropatterned ETTs significantly reduced biofilm by 71% (p = 0.016) compared to smooth ETTs. Moreover, micropatterned ETTs reduced lumen occlusion, in the AP model, as measured by cross-sectional area, in distal (85%, p = 0.005), middle (84%, p = 0.001) and proximal (81%, p = 0.002) sections compared to standard care ETTs. Micropatterned ETTs reduced the volume of secretion accumulation in a sheep model of occlusion by 61% (p < 0.001) after 24 h of mechanical ventilation. Importantly, micropatterned ETTs reduced the rise in ventilation peak inspiratory pressures over time by as much as 49% (p = 0.005) compared to standard care ETTs. Micropatterned ETTs, demonstrated here to reduce bacterial contamination and mucus occlusion, will have the capacity to limit complications occurring during mechanical ventilation and ultimately improve patient care.
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Affiliation(s)
- Ethan E Mann
- Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA
| | - Chelsea M Magin
- Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA
| | - M Ryan Mettetal
- Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA
| | - Rhea M May
- Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA
| | - MiKayla M Henry
- Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA
| | - Heather DeLoid
- Preclinical Translational Services, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Justin Prater
- Preclinical Translational Services, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Lauren Sullivan
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - John G Thomas
- Department of Microbiology and Laboratory Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Mark D Twite
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Albert E Parker
- Department of Mathematical Sciences, Center for Biofilm Engineering, Montana State University, Bozeman, MT, USA
| | - Anthony B Brennan
- Department of Materials Science & Engineering, University of Florida, Gainesville, FL, USA.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Shravanthi T Reddy
- Sharklet Technologies, Inc., 12635 E Montview Blvd., Suite 155, Aurora, CO, 80045, USA.
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11
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Aguilera Xiol E, Li Bassi G, Wyncoll D, Ntoumenopoulos G, Fernandez-Barat L, Marti JD, Comaru T, De Rosa F, Rigol M, Rinaudo M, Ferrer M, Torres A. Tracheal tube biofilm removal through a novel closed-suctioning system: an experimental study. Br J Anaesth 2016; 115:775-83. [PMID: 26475806 DOI: 10.1093/bja/aev340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tracheal tube biofilm develops during mechanical ventilation. We compared a novel closed-suctioning system vs standard closed-suctioning system in the prevention of tracheal tube biofilm. METHODS Eighteen pigs, on mechanical ventilation for 76 h, with P. aeruginosa pneumonia were randomized to be tracheally suctioned via the KIMVENT* closed-suctioning system (control group) or a novel closed-suctioning system (treatment group), designed to remove tracheal tube biofilm through saline jets and an inflatable balloon. Upon autopsy, two tracheal tube hemi-sections were dissected for confocal and scanning electron microscopy. Biofilm area, maximal and minimal thickness were computed. Biofilm stage was assessed. RESULTS Sixteen animals were included in the final analysis. In the treatment and control group, the mean (sd) pulmonary burden was 3.34 (1.28) and 4.17 (1.09) log cfu gr(-1), respectively (P=0.18). Tracheal tube P. aeruginosa colonization was 5.6 (4.9-6.3) and 6.2 (5.6-6.9) cfu ml(-1) (median and interquartile range) in the treatment and control group, respectively (P=0.23). In the treatment group, median biofilm area was 3.65 (3.22-4.21) log10 μm2 compared with 4.49 (4.27-4.52) log10 μm2 in the control group (P=0.031). In the treatment and control groups, the maximal biofilm thickness was 48.3 (26.7-71.2) µm (median and interquartile range) and 88.8 (43.8-125.7) µm, respectively. The minimal thickness in the treatment and control group was 0.6 (0-4.0) µm and 23.7 (5.3-27.8) µm (P=0.040) (P=0.017). Earlier stages of biofilm development were found in the treatment group (P<0.001). CONCLUSIONS The novel CSS reduces biofilm accumulation within the tracheal tube. A clinical trial is required to confirm these findings and the impact on major outcomes.
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Affiliation(s)
- E Aguilera Xiol
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain
| | - G Li Bassi
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain University of Barcelona, Barcelona, Spain
| | - D Wyncoll
- Critical Care Unit, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - G Ntoumenopoulos
- Critical Care Unit, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom Physiotherapy Department, Guy's & St Thomas' NHS Foundation Trust, United Kingdom School of Physiotherapy, Australian Catholic University, North Sydney Campus, North Sydney, Australia
| | - L Fernandez-Barat
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain
| | - J D Marti
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain
| | - T Comaru
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain
| | - F De Rosa
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain University of Milan, Milan, Italy
| | - M Rigol
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain Department of Cardiology, Hospital Clinic, Barcelona, Spain
| | - M Rinaudo
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain
| | - M Ferrer
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain University of Barcelona, Barcelona, Spain
| | - A Torres
- Department of Pulmonary and Critical Care Medicine, Division of Animal Experimentation, Thorax Institute, Hospital Clínic, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Mallorca, Spain University of Barcelona, Barcelona, Spain
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Lellouche F. Quelle technique d’humidification pour la ventilation invasive et non invasive ? MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1131-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Doyle A, Mariyaselvam M, Wijewardena G, English N, Gent E, Young P. The simultaneous use of a heat and moisture exchanger and a heated humidifier causes critical airway occlusion in less than 24 hours. J Crit Care 2015; 30:863.e1-3. [PMID: 25937239 DOI: 10.1016/j.jcrc.2015.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/28/2015] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Heat and moisture exchangers (HMEs) and heated humidifiers (HHs) may be used together inadvertently. Such an incident occurred at our institution resulting in airway occlusion. MATERIAL AND METHODS A bench-top study was conducted to compare the incidence of airway occlusion when using (1) no airway humidification, (2) HME alone, (3) HH alone, and (4) both HME and HH in combination as part of a standard breathing circuit. RESULTS The simultaneous use of a HME and a HH was associated with a reduction in tidal volume (no airway humidification, P ≤ .05; HME alone, P ≤ .01; and HH alone, P ≤ .01) and an increased incidence of airway occlusion (no airway humidification, 0/7; HME alone, 0/7; HH alone, 0/7; and HME and HH in combination, 7/7; P < .0001). CONCLUSIONS The use of a HME and a HH in combination is likely to result in airway occlusion. Precautions should be taken to ensure that both systems are not used together in clinical practice.
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Affiliation(s)
- Alexander Doyle
- Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, UK, PE30 4ET; Specialty trainee, Barts and the London School of Anaesthesia, The Royal London Hospital, Whitechapel, London, UK, E1 1BB
| | - Maryanne Mariyaselvam
- Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, UK, PE30 4ET
| | - Gayathri Wijewardena
- Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, UK, PE30 4ET
| | - Natalie English
- Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, UK, PE30 4ET
| | - Emma Gent
- Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, UK, PE30 4ET
| | - Peter Young
- Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, UK, PE30 4ET.
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Tracheal tube obstruction in mechanically ventilated patients assessed by high-resolution computed tomography. Anesthesiology 2015; 121:1226-35. [PMID: 25254903 DOI: 10.1097/aln.0000000000000455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Tracheal intubation compromises mucus clearance and secretions accumulate inside the tracheal tube (TT). The aim of this study was to evaluate with a novel methodology TT luminal obstruction in critically ill patients. METHODS This was a three-phase study: (1) the authors collected 20 TTs at extubation. High-resolution computed tomography (CT) was performed to determine cross-sectional area (CSA) and mucus distribution within the TT; (2) five TTs partially filled with silicone were used to correlate high-resolution CT results and increased airflow resistance; and (3) 20 chest CT scans of intubated patients were reviewed for detection of secretions in ventilated patients' TT. RESULTS Postextubation TTs showed a maximum CSA reduction of (mean±SD) 24.9±3.9% (range 3.3 to 71.2%) after a median intubation of 4.5 (interquartile range 2.5 to 6.5) days. CSA progressively decreased from oral to lung end of used TTs. The luminal volume of air was different between used and new TTs for all internal diameters (P<0.01 for new vs. used TTs for all studied internal diameters). The relationship between pressure drop and increasing airflow rates was nonlinear and depended on minimum CSA available to ventilation. Weak correlation was found between TT occlusion and days of intubation (R²=0.352, P=0.006). With standard clinical chest CT scans, 6 of 20 TTs showed measurable secretions with a CSA reduction of 24.0±3.9%. CONCLUSIONS TT luminal narrowing is a common finding and correlates with increased airflow resistance. The authors propose high-resolution CT as a novel technique to visualize and quantify secretions collected within the TT lumen.
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Coppadoro A, Bellani G, Bronco A, Borsa R, Lucchini A, Bramati S, Avalli L, Marcolin R, Pesenti A. Measurement of endotracheal tube secretions volume by micro computed tomography (MicroCT) scan: an experimental and clinical study. BMC Anesthesiol 2014; 14:22. [PMID: 24678963 PMCID: PMC3986655 DOI: 10.1186/1471-2253-14-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 03/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Biofilm accumulates within the endotracheal tube (ETT) early after intubation. Contaminated secretions in the ETT are associated with increased risk for microbial dissemination in the distal airways and increased resistance to airflow. We evaluated the effectiveness of micro computed tomography (MicroCT) for the quantification of ETT inner volume reduction in critically ill patients. METHODS We injected a known amount of gel into unused ETT to simulate secretions. We calculated the volume of gel analyzing MicroCT scans for a length of 20 cm. We then collected eleven ETTs after extubation of critically ill patients, recording clinical and demographical data. We assessed the amount of secretions by MicroCT and obtained ETT microbiological cultures. RESULTS Gel volumes assessed by MicroCT strongly correlated with injected gel volumes (p < 0.001, r2 = 0.999).MicroCT revealed the accumulation of secretions on all the ETTs (median 0.154, IQR:0.02-0.837 mL), corresponding to an average cross-sectional area reduction of 1.7%. The amount of secretions inversely correlated with patients' age (p = 0.011, rho = -0.727) but not with days of intubation, SAPS2, PaO2/FiO2 assessed on admission. Accumulation of secretions was higher in the cuff region (p = 0.003). Microbial growth occurred in cultures from 9/11 ETTs, and did not correlate with secretions amount. In 7/11 cases the same microbes were identified also in tracheal aspirates. CONCLUSIONS MicroCT appears as a feasible and precise technique to measure volume of secretions within ETTs after extubation. In patients, secretions tend to accumulate in the cuff region, with high variability among patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Antonio Pesenti
- Department of Health Sciences, University of Milan-Bicocca, Monza, Italy.
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Use of high-definition computed tomography to assess endotracheal tube luminal narrowing after mechanical ventilation. Anesthesiology 2013; 119:202. [PMID: 23535503 DOI: 10.1097/aln.0b013e318291022d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Effect of mechanical cleaning of endotracheal tubes with sterile urethral catheters to reduce biofilm formation in ventilator patients. Pediatr Crit Care Med 2013; 14:e338-43. [PMID: 23897241 DOI: 10.1097/pcc.0b013e31828aa5d6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the effectiveness of mechanical cleaning with sterile urethral catheters to prevent formation of biofilms on endotracheal tubes. METHODS Forty-five children were randomized in equal numbers to endotracheal tube cleaning group for three times a day (group A), twice daily (group B), or to a control group with no endotracheal tube cleaning (group C). Bacterial studies and confocal laser scanning microscopy were performed to assess bacterial colonization and biofilm thickness on the internal surface of the endotracheal tube. RESULTS In group B, the quantities of viable bacteria adhering to the endotracheal tube after 1 day of ventilation were similar to the control group but were significantly less by 3 days (p < 0.05). The quantities of viable bacteria adhering to the endotracheal tube in group A were significantly lower than group C from day 1 to day 7 (p < 0.05). The numbers of culture-positive endotracheal tube and lower respiratory tract secretions were both reduced in groups A and B compared with group C. Confocal laser scanning microscopy showed progressive development of mature biofilms in group C. Scattered bacteria were seen in group A with no biofilm formation. In group B, a small amount of extracellular polymeric substance was seen, with more bacterial cells than in group A. The biofilms in group B were significantly thinner than those in group C (p < 0.05). The occurrence of ventilator-associated pneumonia was significantly reduced by endotracheal tube cleaning. CONCLUSION Mechanical cleaning with sterile urethral catheters reduced bacterial colonization, prevented formation of endotracheal tube biofilm, and reduced the occurrence of ventilator-associated pneumonia.
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Respiratory therapy device modifications to prevent ventilator-associated pneumonia. Curr Opin Infect Dis 2013; 26:175-83. [PMID: 23286937 DOI: 10.1097/qco.0b013e32835d3349] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Ventilator-associated pneumonia (VAP) is a controversial entity in the field of critical care. After years of research and significant efforts from regulatory agencies and hospitals, this complication is still frequently affecting mechanically ventilated patients, making VAP an active battleground for research. As a result, several preventive measures have recently been tested in experimental and clinical trials. Our interest is focused on those innovations related to the endotracheal tube (ETT). RECENT FINDINGS Four ETT-related VAP causative mechanisms are reviewed, together with different associated potential solutions. Technologies such as the subglottic secretion drainage and the Mucus Slurper have been studied to eliminate subglottic secretion pooling. Novel designs for the cuff and the management of its pressure may avoid leakage. Antimicrobial coatings can prevent endoluminal biofilm formation, whereas using an ETT cleaning device may also be beneficial. Finally, preserving the tracheal ciliary function will keep our best physiologic protection active. SUMMARY VAP prevention strategies are a continuously evolving field. Being able to identify the most valuable ideas needs a deep understanding of the disease pathophysiology. The role of the ETT is crucial and there is need for our standards of care to improve. This may soon be possible with newer technologies becoming increasingly available to clinicians.
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Berra L, Coppadoro A, Bittner EA, Kolobow T, Laquerriere P, Pohlmann JR, Bramati S, Moss J, Pesenti A. A clinical assessment of the Mucus Shaver: a device to keep the endotracheal tube free from secretions. Crit Care Med 2012; 40:119-24. [PMID: 21926595 PMCID: PMC3405906 DOI: 10.1097/ccm.0b013e31822e9fe3] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE : We evaluated a new device designed to clean the endotracheal tube in mechanically ventilated patients, the Mucus Shaver. DESIGN : Prospective, randomized trial. SETTING : University hospital intensive care unit. PATIENTS : We enrolled 24 patients expected to remain ventilated for >72 hrs. INTERVENTIONS : The Mucus Shaver is a concentric inflatable catheter for the removal of mucus and secretions from the interior surface of the endotracheal tube. The Mucus Shaver is advanced to the distal endotracheal tube tip, inflated, and subsequently withdrawn over a period of 3-5 secs. Patients were prospectively randomized within 2 hrs of intubation to receive standard endotracheal tube suctioning treatment or standard suctioning plus Mucus Shaver use until extubation. MEASUREMENTS AND MAIN RESULTS : During the study period, demographic data, recent medical history, adverse events, and staff evaluation of the Mucus Shaver were recorded. At extubation, each endotracheal tube was removed, cultured, and analyzed by scanning electron microscopy. Twelve patients were assigned to the study group and 12 were assigned to the control group. No adverse events related to the use of the Mucus Shaver were observed. At extubation, only one endotracheal tube from the Mucus Shaver group was colonized, whereas in the control group ten endotracheal tubes were colonized (8% vs. 83%; p < .001). Scanning electron microscopy showed little secretions on the endotracheal tubes from the study group, whereas thick bacterial deposits were present on all the endotracheal tubes from the control group (p < .001 by Fisher exact test, using a maximum biofilm thickness of 30 μm as cut-off). The nursing staff was satisfied by the overall safety, feasibility, and efficacy of the Mucus Shaver. CONCLUSIONS : The Mucus Shaver is a safe, feasible, and efficient device for endotracheal tube cleaning in the clinical setting. The Mucus Shaver is helpful in preventing endotracheal tube colonization by potentially harmful microorganisms.
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Affiliation(s)
- Lorenzo Berra
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Park YS, Kee YW, Park KS, Lee J, Lee SM, Yim JJ, Yoo CG, Kim YW, Han SK, Yang SC. Sound analysis in an in vitro endotracheal tube model. Korean J Intern Med 2011; 26:421-6. [PMID: 22205842 PMCID: PMC3245390 DOI: 10.3904/kjim.2011.26.4.421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 06/17/2011] [Accepted: 06/20/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Complete endotracheal tube obstruction is a medical emergency, and partial occlusion causes increased breathing rates and failure to wean off mechanical ventilation. Partial occlusion may be underestimated due to the lack of proper detection methods. We tested whether the sound of an endotracheal tube could be used to detect an endotracheal tube obstruction using an in vitro model. METHODS An endotracheal tube was connected to a ventilator on one end and a test lung on the other. Sounds were recorded with a microphone located inside the endotracheal tube via a connector. During mechanical ventilation, we changed the endotracheal tube internal diameter from 5.0 to 8.0 mm and different grades of obstruction at different sites were used along the tube. Sound energy was compared among the different conditions. RESULTS The energy of endotracheal tube sounds was positively correlated with the internal diameter and negatively correlated with the degree of obstruction. The rate of decline in energy differed with obstruction location. When the obstruction was more distal, the rate of decline in endotracheal sound energy was more rapid. CONCLUSIONS Changes in the sound of an endotracheal tube can be used to detect an obstruction. Further studies are needed for clinical application.
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Affiliation(s)
- Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Wook Kee
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang Suk Park
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seok-Chul Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
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Morán I, Cabello B, Manero E, Mancebo J. Comparison of the effects of two humidifier systems on endotracheal tube resistance. Intensive Care Med 2011; 37:1773-9. [PMID: 21946924 DOI: 10.1007/s00134-011-2351-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 09/01/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the effects of two humidifier systems on endotracheal tube (ETT) resistance during mechanical ventilation, either an active heated humidifier (HH) or a passive heat and moisture exchanger (HME) was selected using current clinical recommendations. METHODS This was a prospective clinical cohort study performed in an intensive care unit. Gas conditioning was performed using the HH in 22 patients and the HME in another 22. Patients were matched for endotracheal tube diameter, days of mechanical ventilation, simplified acute physiology score II (SAPS II), and fluid balance. RESULTS Used-ETT resistance was measured immediately after extubation. Unused-ETT resistance was calculated with an identical, clean ETT. No differences were found between the HH and HME groups in ETT diameter (7.9 ± 0.4 vs. 7.9 ± 0.3 mm; p = 0.98), days of mechanical ventilation (11.3 ± 7.7 vs. 9.5 ± 4.5; p = 0.34), SAPS II (41.0 ± 13.6 vs. 42.0 ± 11.7; p = 0.79), or fluid balance (-2,552 ± 6,268 vs. -2,579 ± 5,422 mL; p = 0.98). ETT resistance increased from intubation to extubation: from 6.8 ± 1.1 to 10.6 ± 4.3 cmH(2)O L(-1) s(-1) in the HH group, (p < 0.001) and from 6.8 ± 1.1 to 10.2 ± 3.8 cmH(2)O L(-1) s(-1) in the HME group (p < 0.001), which is a 53% average increase in resistive load. CONCLUSIONS We did not find differences between the two types of humidifiers in terms of airflow resistance during prolonged mechanical ventilation when the devices were selected on the basis of individual clinical needs. The increase in resistive load is physiologically relevant.
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Affiliation(s)
- Indalecio Morán
- Servei Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
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Biel MA, Sievert C, Usacheva M, Teichert M, Wedell E, Loebel N, Rose A, Zimmermann R. Reduction of Endotracheal Tube Biofilms Using Antimicrobial Photodynamic Therapy. Lasers Surg Med 2011; 43:586-590. [PMID: 21987599 DOI: 10.1002/lsm.21103] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND: Ventilator-associated pneumonia (VAP) is reported to occur in 12 to 25% of patients who require mechanical ventilation with a mortality rate of 24 to 71%. The endotracheal (ET) tube has long been recognized as a major factor in the development of VAP since biofilm harbored within the ET tube become dislodged during mechanical ventilation and have direct access to the lungs. The objective of this study was to demonstrate the safety and effectiveness of a non-invasive antimicrobial photodynamic therapy (aPDT) treatment method of eradicating antibiotic resistant biofilms from ET tubes in an in vitro model. METHODS: Antibiotic resistant polymicrobial biofilms of Pseudomonas aerugenosa and MRSA were grown in ET tubes and treated, under standard ventilator conditions, with a methylene blue (MB) photosensitizer and 664nm non-thermal activating light. Cultures of the lumen of the ET tube were obtained before and after light treatment to determine efficacy of biofilm reduction. RESULTS: The in vitro ET tube biofilm study demonstrated that aPDT reduced the ET tube polymicrobial biofilm by >99.9% (p<0.05%) after a single treatment. CONCLUSIONS: MB aPDT can effectively treat polymicrobial antibiotic resistant biofilms in an ET tube.
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Affiliation(s)
- Merrill A Biel
- Advanced Photodynamic Technologies, Inc., 2929 University Avenue SE, Suite 208, Minneapolis, MN 55414
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Efrati S, Deutsch I, Gurman GM, Noff M, Conti G. Tracheal pressure and endotracheal tube obstruction can be detected by continuous cuff pressure monitoring: in vitro pilot study. Intensive Care Med 2010; 36:984-90. [DOI: 10.1007/s00134-010-1835-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 11/14/2009] [Indexed: 12/12/2022]
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Kiraly NJ, Tingay DG, Mills JF, Morley CJ, Dargaville PA, Copnell B. The effects of closed endotracheal suction on ventilation during conventional and high-frequency oscillatory ventilation. Pediatr Res 2009; 66:400-4. [PMID: 19581839 DOI: 10.1203/pdr.0b013e3181b337ec] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In newborn infants, closed endotracheal tube (ETT) suction may reduce associated adverse effects, but it is not clear whether ventilation is maintained during the procedure. We aimed to determine the effect of ETT size, catheter size, and suction pressure on ventilation parameters measured distal to the ETT. Suction was performed on a test lung, ventilated with conventional (CMV) and high-frequency oscillatory ventilation (HFOV) using ETT sizes 2.5-4.0 mm, catheter sizes 5-8 French gauge (Fr), and suction pressures 80-200 mm Hg. Tracheal and circuit peak inspiratory pressure, positive end-expiratory pressure, and tracheal tidal volume (VT) were recorded for each suction episode. During both CMV and HFOV, tracheal pressures and VT were considerably reduced by suctioning; this reduction was dependent on the combination of ETT, catheter, and suction pressure. Loss of VT, inflation pressure (CMV), and pressure amplitude (HFOV) occurred primarily with insertion of the catheter, and loss of end-expiratory pressure (CMV) and mean tracheal pressure (HFOV) occurred with the application of suction. Circuit pressures were reduced to lesser degree. We conclude that airway pressures and VT are not maintained during closed endotracheal suction with either CMV or HFOV, and choice of equipment and settings will affect the degree of interruption to ventilation.
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Affiliation(s)
- Nicholas J Kiraly
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
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Abstract
PURPOSE OF REVIEW Although drug therapy is most commonly delivered via the intravenous route, novel inhaled agents have been introduced for use in the ICU. Additionally, drugs previously delivered intravenously are now being delivered via the respiratory tract in an effort to reduce systemic toxicity and maximize effectiveness. RECENT FINDINGS Aerosolized antibiotics have seen increased use in an effort to reduce systemic effects, reduce ventilator-associated pneumonia, and direct high drug concentrations at the site of infection. Drug-resistant pneumonia has also been effectively treated with aerosolized antibiotics. Secretion management includes a host of devices, therapies, and drugs, but the evidence for these is scant. Cardiac drugs via the endotracheal route should be used only when intravenous access is delayed. Inhaled nitric oxide has a defined role in care of infants, although new indications have limited and conflicting data. The use of helium-oxygen mixtures provides symptom relief in a wide variety of scenarios associated with turbulent flow in large airways. SUMMARY Inhaled nitric oxide has an established role in neonatal intensive care and a limited role in adult intensive care. Heliox provides symptom relief, but at present cannot be considered routine as a consequence of the multiple technological challenges. Inhaled antimicrobials appear to provide a therapeutic advantage in select individuals with pneumonia. Secretion management is best achieved by adequate humidification and as needed suctioning. The role of inhaled carbon monoxide in critical care holds significant promise, but is currently in early clinical trials.
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Wilson AM, Gray DM, Thomas JG. Increases in endotracheal tube resistance are unpredictable relative to duration of intubation. Chest 2009; 136:1006-1013. [PMID: 19411293 DOI: 10.1378/chest.08-1938] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Accumulated secretions after intubation can affect the resistance of an endotracheal tube (ETT). Our objective was to measure extubated patient tubes and size-matched controls to evaluate differences in resistance. METHODS New ETTs, with internal diameters of 7.0 through 8.5 mm, were tested as controls to establish the resistance of each size group as measured by pressure drop. Measurements were obtained using a mass flowmeter and pressure transducer. Pressure drop was measured at three flow rates. Seventy-one patient ETTs were evaluated after extubation by an identical method and compared with controls. RESULTS In each control group, pressure drop was tightly clustered with low variation and no overlap between sizes. A total of 73 to 79% of the patient ETTs had a pressure drop of > 3 SDs of size-matched controls at all flow rates. Pressure drop in 48 to 56% (across three flow rates) of extubated tubes was equivalent to the next smaller size of controls. At 60 and 90 L/min, 10% and 15% of patient tubes, respectively, had the pressure drop of a control tube three sizes smaller. The pressure drop was unpredictable relative to the duration of intubation. CONCLUSIONS Organized secretions can significantly increase resistance as measured by the pressure drop of ETTs. The degree of change was highly variable, occurs in all sizes, and was unrelated to the duration of intubation. The performance of an ETT may be comparable to new tubes one to four sizes smaller. This may impact the tolerance of ventilator weaning.
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Affiliation(s)
- Alison M Wilson
- Departments of Surgery, West Virginia University, Morgantown, WV.
| | - Dana M Gray
- Pathology, West Virginia University, Morgantown, WV
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Unoki T, Serita A, Grap MJ. Automatic Tube Compensation During Weaning From Mechanical Ventilation. Crit Care Nurse 2008. [DOI: 10.4037/ccn2008.28.4.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Takeshi Unoki
- Takeshi Unoki is a senior assistant professor in the School of Nursing at St. Luke’s College of Nursing, Tokyo, Japan. He was a postdoctoral fellow in the School of Nursing at Virginia Commonwealth University in Richmond when this article was written
| | - Akimichi Serita
- Akimichi Serita is a staff nurse in an intensive care unit at Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Mary Jo Grap
- Mary Jo Grap is a professor in the School of Nursing at Virginia Commonwealth University in Richmond
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Lindgren S, Odenstedt H, Erlandsson K, Grivans C, Lundin S, Stenqvist O. Bronchoscopic suctioning may cause lung collapse: a lung model and clinical evaluation. Acta Anaesthesiol Scand 2008; 52:209-18. [PMID: 18005383 DOI: 10.1111/j.1399-6576.2007.01499.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To assess lung volume changes during and after bronchoscopic suctioning during volume or pressure-controlled ventilation (VCV or PCV). DESIGN Bench test and patient study. PARTICIPANTS Ventilator-treated acute lung injury (ALI) patients. SETTING University research laboratory and general adult intensive care unit of a university hospital. INTERVENTIONS Bronchoscopic suctioning with a 12 or 16 Fr bronchoscope during VCV or PCV. MEASUREMENTS AND RESULTS Suction flow at vacuum levels of -20 to -80 kPa was measured with a Timeter(trade mark) instrument. In a water-filled lung model, airway pressure, functional residual capacity (FRC) and tidal volume were measured during bronchoscopic suctioning. In 13 ICU patients, a 16 Fr bronchoscope was inserted into the left or the right main bronchus during VCV or PCV and suctioning was performed. Ventilation was monitored with electric impedance tomography (EIT) and FRC with a modified N(2) washout/in technique. Airway pressure was measured via a pressure line in the endotracheal tube. Suction flow through the 16 Fr bronchoscope was 5 l/min at a vacuum level of -20 kPa and 17 l/min at -80 kPa. Derecruitment was pronounced during suctioning and FRC decreased with -479+/-472 ml, P<0.001. CONCLUSIONS Suction flow through the bronchoscope at the vacuum levels commonly used is well above minute ventilation in most ALI patients. The ventilator was unable to deliver enough volume in either VCV or PCV to maintain FRC and tracheal pressure decreased below atmospheric pressure.
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Affiliation(s)
- S Lindgren
- Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden.
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Li Bassi G, Curto F, Zanella A, Stylianou M, Kolobow T. A 72-hour study to test the efficacy and safety of the "Mucus Slurper" in mechanically ventilated sheep. Crit Care Med 2007; 35:906-11. [PMID: 17255853 DOI: 10.1097/01.ccm.0000257332.62358.0e] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In patients intubated with endotracheal tubes (ETTs), suctioning is routinely performed to remove mucus from within the ETT and trachea. The Mucus Slurper is a novel ETT with built-in suction ports arranged radially at its tip. We evaluated the safety and efficacy of the Mucus Slurper, compared with conventional tracheal suction, to prevent airway obstruction in sheep with the ETT and trachea oriented below horizontal. DESIGN Prospective randomized animal study. SETTING Animal research facility at the National Institutes of Health. SUBJECTS Twelve healthy sheep. INTERVENTIONS Sheep were randomized to be intubated with either the Mucus Slurper (study group) or a Hi-Lo Tracheal Tube (Mallinckrodt, St. Louis, MO) (control group) and mechanically ventilated for 72 hrs. In the study group, automatic, timed tracheal aspiration lasted 0.3 secs, was repeated every 2 mins, and was synchronized with the early expiratory phase. In the control group, tracheal suction was performed every 6 hrs or as required. MEASUREMENTS AND MAIN RESULTS In the control group, tracheal secretions accumulated progressively within the ETT and the trachea. In the study group, all mucus that reached the tip of the Mucus Slurper was aspirated, keeping the lumen of the ETT, and proximal trachea, free from secretions. In the study group, expiratory water trap protein concentration, a crude index to measure mucus drainage through the ETT, was consistently less than the control group (p < .001). At autopsy, no macroscopic injury to the tracheal mucosa was found in either group. In the study group, the respiratory circuit was less colonized than in the control group. There were no statistically significant differences between the two groups in bacterial colonization of the lungs/bronchi. CONCLUSIONS The Mucus Slurper, combined with orientation of the trachea below horizontal, prevents accumulation of secretions within the lumen of the ETT and trachea, without need for conventional tracheal suctioning.
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Affiliation(s)
- Gianluigi Li Bassi
- Section on Pulmonary and Cardiac Assist Devices, Pulmonary and Critical Care Medicine Branch, Division of Epidemiology and Clinical Applications, Office of Biostatics Research, NHLBI, NIH, Bethesda, MD 20892, USA.
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31
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Reply to the comment by Dr. Spronk et al. Intensive Care Med 2006. [DOI: 10.1007/s00134-006-0403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kawati R, Vimlati L, Guttmann J, Hedenstierna G, Sjöstrand U, Schumann S, Lichtwarck-Aschoff M. Change in Expiratory Flow Detects Partial Endotracheal Tube Obstruction in Pressure-Controlled Ventilation. Anesth Analg 2006; 103:650-7. [PMID: 16931676 DOI: 10.1213/01.ane.0000229777.80271.4a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Only extreme degrees of endotracheal tube (ETT) narrowing can be detected with monitoring of tidal volume (V(T)) during pressure-controlled ventilation (PCV). To assess the degree of ETT obstruction in PCV and to compare it to V(T) monitoring, we produced 3 levels of partial ETT obstruction in 11 healthy anesthetized piglets using ETTs of 4 different inner diameters (IDs 9.0, 8.0, 7.0, and 6.0 mm). An expiratory flow over volume ((e)-V) curve was plotted and the time constant (tau(e)) at 15% of expiration time (T(e)) was calculated. We also calculated the fractional volume expired during the first 15% of T(e) (V(ex fract,15)) and compared those variables to full expiratory V(T) for each of the 3 obstructions. V(T) monitoring failed to detect ETT narrowing. By contrast, V(ex fract,15) decreased and tau(e) increased significantly with increasing ETT narrowing (for IDs 9.0, 8.0, 7.0, and 6.0, mean V(ex fract,15) was 195, 180, 146, and 134 mL respectively and mean tau(e) was 380, 491, 635, 794 ms for IDs 9.0, 8.0, 7.0, and 6.0 respectively). We conclude that when the elastic recoil that drives (e) is appropriately considered, analysis of (e) and V(ex fract,15) detects partial ETT obstruction during PCV.
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Affiliation(s)
- Rafael Kawati
- Department of Surgical Sciences/Anesthesiology & Intensive Care, Uppsala University Hospital, Uppsala, Sweden.
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Detection of partial endotracheal tube obstruction by forced pressure oscillations. Respir Physiol Neurobiol 2006; 155:227-33. [PMID: 16861058 DOI: 10.1016/j.resp.2006.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Revised: 05/09/2006] [Accepted: 05/29/2006] [Indexed: 11/23/2022]
Abstract
Rapid airway occlusions during mechanical ventilation are followed immediately by high-frequency pressure oscillations. To answer the question if the frequency of forced pressure oscillations is an indicator for partial obstruction of the endotracheal tube (ETT) we performed mathematical simulations and studies in a ventilated physical lung model. Model-derived predictions were evaluated in seven healthy volunteers. Partial ETT obstruction was mimicked by decreasing the inner diameter (ID) of the ETT. In the physical model ETTs of different ID were used. In spontaneously breathing volunteers viscous fluid was applied into the ETT's lumen. According to the predictions derived from mathematical simulations, narrowing of the ETT's ID from 9.0 to 7.0mm decreased the frequency of the pressure oscillations by 11% while changes of the respiratory system's compliance had no effect. In volunteers, a similar reduction (10.9%) was found when 5 ml fluid were applied. We conclude that analysis of pressure oscillations after flow interruption offers a tool for non-invasive detection of partial ETT obstruction.
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Berra L, Curto F, Li Bassi G, Laquerriere P, Baccarelli A, Kolobow T. Antibacterial-coated tracheal tubes cleaned with the Mucus Shaver : a novel method to retain long-term bactericidal activity of coated tracheal tubes. Intensive Care Med 2006; 32:888-93. [PMID: 16601964 DOI: 10.1007/s00134-006-0125-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2005] [Accepted: 02/21/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the long-term benefit from antibacterial coatings of the tracheal tube (ETT), and to keep clean the lumen of the ETT. DESIGN Experimental animal study. SETTING USA National Institutes of Health. SUBJECTS Twelve sheep. INTERVENTIONS Twelve ETTs were internally dip-coated with a silver-sulfadiazine in polyurethane. We developed a concentric inflatable silicone rubber "razor", the Mucus Shaver (MS), to shave the ETT lumen free of mucus. In a single pass, we cleaned all mucus from the internal surface of the ETT. CONTROL GROUP Five intubated sheep were mechanically ventilated for 72 h. The ETT was suctioned every 6 h. STUDY GROUP Six sheep were intubated and mechanically ventilated for 72 h. The ETT was suctioned and cleaned with the MS every 6 h. An additional sheep was intubated and mechanically ventilated for 168 h. Bacteriologic studies and scanning electron microscopy were performed to assess bacterial colonization and thickness of secretions on the internal surface of the ETT. MEASUREMENTS AND MAIN RESULTS In the control group, the ETT was always heavily colonized: median debris thickness was 380 microm, range 270-550 microm. In the study group, there was no colonization and no secretions in the ETT, except for three ETT that were colonized solely at the very tip. CONCLUSIONS Silver-based coating of ETT cleaned with the MS every 6 h significantly reduces accumulation of mucus/secretion and bacterial growth within the ETT following 72 h of mechanical ventilation.
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Affiliation(s)
- Lorenzo Berra
- Massachusetts General Hospital, Department of Anesthesia and Critical Care, Boston MA, USA.
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Monitoring Intra-Cuff Pressure in Subglottic Aspiration. Crit Care Med 2005. [DOI: 10.1097/01.ccm.0000166887.58141.e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Andrews P, Azoulay E, Antonelli M, Brochard L, Brun-Buisson C, Dobb G, Fagon JY, Gerlach H, Groeneveld J, Mancebo J, Metnitz P, Nava S, Pugin J, Pinsky M, Radermacher P, Richard C, Tasker R, Vallet B. Year in review in intensive care medicine, 2004. I. Respiratory failure, infection, and sepsis. Intensive Care Med 2005; 31:28-40. [PMID: 15609018 PMCID: PMC7079835 DOI: 10.1007/s00134-004-2529-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Accepted: 11/26/2004] [Indexed: 01/15/2023]
Affiliation(s)
- Peter Andrews
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Elie Azoulay
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Massimo Antonelli
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Laurent Brochard
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Christian Brun-Buisson
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Geoffrey Dobb
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Jean-Yves Fagon
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Herwig Gerlach
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Johan Groeneveld
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Jordi Mancebo
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Philipp Metnitz
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Stefano Nava
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Jerome Pugin
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Michael Pinsky
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Peter Radermacher
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Christian Richard
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Robert Tasker
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Benoit Vallet
- Medical Intensive Care Unit, University Hospital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
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