title: Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate.
abstract: BACKGROUND
  The reduction of instrumental dead space is a recognized approach to preventing ventilation-induced lung injury in premature infants. However, there are no published data regarding the effectiveness of instrumental dead-space reduction in endotracheal tube (ETT) connectors. We tested the impact of the Y-piece/ETT connector pairs with reduced instrumental dead space on CO2 elimination in a model of the premature neonate lung.
  
  
  METHODS
  The standard ETT connector was compared with a low-dead-space ETT connector and with a standard connector equipped with an insert. We compared the setups by measuring the CO2 elimination rate in an artificial lung ventilated via the connectors. The lung was connected to a ventilator via a standard circuit, a 2.5-mm ETT, and one of the connectors under investigation. The ventilator was run in volume-controlled continuous mandatory ventilation mode.
  
  
  RESULTS
  The low-dead-space ETT connector/Y-piece and insert-equipped standard connector/Y-piece pairs had instrumental dead space reduced by 36 and 67%, respectively. With set tidal volumes (VT) of 2.5, 5, and 10 mL, in comparison with the standard ETT connector, the low-dead-space connector reduced CO2 elimination time by 4.5% (P < .05), 4.4% (P < .01), and 7.1% (not significant), respectively. The insert-equipped standard connector reduced CO2 elimination time by 13.5, 25.1, and 16.1% (all P < .01). The low-dead-space connector increased inspiratory resistance by 17.8% (P < .01), 9.6% (P < .05), and 5.0% (not significant); the insert-equipped standard connector increased inspiratory resistance by 9.1, 8.4, and 5.9% (all not significant). The low-dead-space connector decreased expiratory resistance by 6.8% (P < .01) and 1.8% (not significant) and increased it by 1.4% (not significant); the insert-equipped standard connector decreased expiratory resistance by 1.5 and 1% and increased it by 1% (all not significant). The low-dead-space connector increased work of breathing by 4.7% (P < .01), 3.8% (P < .01), and 2.5% (not significant); the insert-equipped standard connector increased it by 0.8% (not significant), 2.5% (P < .01), and 2.8% (P < .01).
  
  
  CONCLUSIONS
  Both methods of instrumental dead-space reduction led to improvements in artificial lung ventilation. Negative effects on resistance and work of breathing appeared minimal. Further testing in vivo should be performed to confirm the lung model results and, if successful, translated into clinical practice.
authors.affiliation: Section of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. vadim-ivanov@ouhsc.edu.
authors.forename: Vadim A
authors.initials: VA
authors.lastname: Ivanov
mesh_terms: D004867:Equipment Design; D045853:Exhalation; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D008168:Lung / Q000503:physiopathology; D008953:Models, Anatomic; D011659:Pulmonary Gas Exchange; D012119:Respiration; D012121:Respiration, Artificial / Q000295:instrumentation* / Q000379:methods; D012126:Respiratory Dead Space; D013990:Tidal Volume; D055397:Ventilator-Induced Lung Injury / Q000517:prevention & control*; D012122:Ventilators, Mechanical
keywords: bronchopulmonary dysplasia; endotracheal tube connector; instrumental dead space; ventilator-induced lung injury; very low birthweight infants