A new device to remove obstruction from endotracheal tubes during mechanical ventilation in critically ill patients.
OBJECTIVE
To evaluate the efficiency of a new device developed to remove obstructions from endotracheal tubes (ETT) in mechanically ventilated patients.


METHODS
Open study in mechanically ventilated sedated and paralyzed ICU patients.


METHODS
General ICU and Laboratory of Respiratory Mechanics of the University of Rome "La Sapienza".


METHODS
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.


METHODS
Obstructions to ETT were removed with an experimental "obstruction remover" (OR) MEASUREMENTS: "In vivo" ETT airflow resistance (0.25; 0.5; 0.75; 11/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 0.25 l/s, p < 0.05; from 9 +/- 2.4 to 3.8 +/- 0.8 cmH2O/l/s at 0.5 l/s; from 12.2 +/- 3.5 to 5.7 +/- 1.2 cmH2O/l/s at 0.75 l/s; from 16.9 +/- 6 to 9.3 +/- 3.8 cmH2O/l/s at 1 l/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).


CONCLUSIONS
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.
Conti
G
G
Institute of Anesthesia and Intensive Care, University of Rome La Sapienza, Italy.
Rocco
M
M
De Blasi
R A
RA
Lappa
A
A
Antonelli
M
M
Bufi
M
M
Gasparetto
A
A
D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000175:diagnosis / Q000628:therapy*; D000403:Airway Resistance; D020680:Bronchoscopes; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D013525:Surgical Instruments; D014939:Work of Breathing