Endotracheal tube narrowing after closed-system suctioning: prevalence and risk factors

1999 ◽  
Vol 8 (2) ◽  
pp. 93-100 ◽  
Author(s):  
C Glass ◽  
MJ Grap ◽  
CN Sessler
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Endotracheal Tube ◽  
Closed System ◽  
Contributing Factors ◽  
Tube Size ◽  
Endotracheal Tubes ◽  
Few Data ◽  
Endotracheal Tube Size

BACKGROUND: Few data exist about buildup of secretions within endotracheal tubes of patients treated with closed-system suctioning in the intensive care unit. OBJECTIVES: To describe the extent, prevalence, and distribution of narrowing of endotracheal tubes related to buildup of secretions and to determine contributing factors. METHODS: Forty endotracheal tubes were examined within 4 hours of extubation, after at least 72 hours of use. Data on patients' daily weight and fluid balance, ventilator humidification temperatures, and nurses' descriptions of secretions during the 3 days preceding extubation were recorded. Any secretion debris in the endotracheal tubes was weighed. At 1-cm intervals along the tube, the debris was described and the depth of the debris was measured to the nearest 0.5 mm. RESULTS: Mean duration of intubation was 6.6 days. Two tubes had no debris. Mean overall depth of debris was 0.64 mm, mean greatest depth was 2.0 mm (range, 0-5 mm), and mean weight was 1.16 g. The entire tube was affected, with the greatest depth of debris at the 6- to 9-cm and 13- to 14-cm markings. Duration of intubation correlated with mean greatest depth of debris (r = 0.37, P = .02), mean overall depth of debris (r = 0.48, P = .002), and mean weight of debris (r = 0.38, P = .02). CONCLUSIONS: Endotracheal tubes are markedly narrowed by the buildup of secretions after closed-system suctioning. Duration of intubation, but not endotracheal tube size or amount of secretions, was associated with the degree of narrowing.

scholarly journals Efficacy of Pressure Support in Compensating for Apparatus Work

1993 ◽  
Vol 21 (1) ◽  
pp. 67-71 ◽  
Author(s):  
A. D. Bersten ◽  
A. J. Rutten ◽  
A. E. Vedig
Keyword(s):  
Endotracheal Tube ◽  
Flow Rate ◽  
Pressure Support ◽  
Work Of Breathing ◽  
Inspiratory Flow ◽  
Inspiratory Flow Rate ◽  
Respiratory Muscle Fatigue ◽  
Tube Size ◽  
Endotracheal Tubes ◽  
Endotracheal Tube Size

Breathing through an endotracheal tube, connector, and ventilator demand valve imposes an added load on the respiratory muscles. As respiratory muscle fatigue is thought to be a frequent cause of ventilator dependence, we sought to examine the efficacy of five different ventilators in reducing this imposed work through the application of pressure support ventilation. Using a model of spontaneous breathing, we examined the apparatus work imposed by the Servo 900-C, Puritan Bennett 7200a, Engstrom Erica, Drager EV-A or Hamilton Veolar ventilators, a size 7.0 and 8.0 mm endotracheal tube, and inspiratory flow rates of 40 and 60 l/min. Pressure support of 0, 5, 10, 15, 20 and 30 cm H2O was tested at each experimental condition. Apparatus work was greater with increased inspiratory flow rate and decreased endotracheal tube size, and was lowest for the Servo 900-C and Puritan Bennett 7200a ventilators. Apparatus work fell in a curvilinear fashion when pressure support was applied, with no major difference noted between the five ventilators tested. At an inspiratory flow rate of 40 l/min, a pressure support of 5 and 8 cm H2O compensated for apparatus work through size 8.0 and 7.0 endotracheal tubes and the Servo 900-C and Puritan Bennett 7200a ventilators. However, the maximum negative pressure was greater for the Servo 900-C. The added work of breathing through endotracheal tubes and ventilator demand valves may be compensated for by the application of pressure support. The level of pressure support required depends on inspiratory flow rate, endotracheal tube size, and type of ventilator.

Endotracheal Tube Placement in Infants

PEDIATRICS ◽  
1986 ◽  
Vol 77 (1) ◽  
pp. 132-132
Author(s):  
RICHARD M. HELLER ◽  
ROBERT B. COTTON
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Endotracheal Tube ◽  
Neonatal Intensive Care ◽  
Tube Placement ◽  
Clear Indication ◽  
Depth Of Penetration ◽  
Endotracheal Tubes ◽  
Endotracheal Tube Placement ◽  
The Cost

In Reply.— We agree with Dr Bloch that auscultation is a primary tool for determinig appropriate position of an endotracheal tube. However, experience in a busy neonatal intensive care unit has shown that, even with careful auscultation, endotracheal tubes still become inappropriately positioned, often with serious consequences. Our experience has been that the illuminated endotracheal tube provides a clear indication of depth of penetration when asymmetric lung disease may cause auscultatory findings to be equivocal. Dr Goldenring raises the important point that the cost of the illuminated endotracheal tube is under evaluation at the present time, and as soon as information concerning pricing is available, I will make this information available to the readership of Pediatrics.

Proposed Grading System for Subglottic Stenosis Based on Endotracheal Tube Sizes

1994 ◽  
Vol 103 (4) ◽  
pp. 319-323 ◽  
Author(s):  
Charles M. Myer ◽  
David M. O'Connor ◽  
Robin T. Cotton
Keyword(s):  
Endotracheal Tube ◽  
Tube Size ◽  
Endotracheal Tubes ◽  
Age Appropriate ◽  
Grade Ii ◽  
Grading Scale ◽  
Pass Through ◽  
High Standards ◽  
Endotracheal Tube Size

The classification of airway stenoses has been a problem for many years. As a result, both intradepartmental and interdepartmental comparisons of airway sizes remain difficult. It follows that comparisons of therapeutic maneuvers are even more difficult. A system is proposed that is simple, reproducible, and based on a readily available reference standard. Endotracheal tubes, which are manufactured to high standards of precision and accuracy, can be used to determine the size of an obstructed airway at its smallest point. The endotracheal tube that will pass through the lumen, if one exists, and tolerate normal leak pressures (10 to 25 cm H2O), can be compared to the expected age-appropriate endotracheal tube size. By using the outside diameters of the endotracheal tubes, the maximum percentage of airway obstruction can be determined. We present a conversion of tube size to the proposed grading scale: grade I up to 50% obstruction, grade II from 51% to 70%, and grade III above 70% with any detectable lumen. An airway with no lumen is assigned to grade IV.

Interacting risk factors determine the outcome of patients with a prolonged intensive care unit stay after cardiac surgery

2013 ◽  
Vol 61 (S 01) ◽  
Author(s):  
J Schöttler ◽  
C Grothusen ◽  
T Attmann ◽  
C Friedrich ◽  
S Freitag-Wolf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Unit Stay

Readmission to the Intensive Care Unit after Fast-Track Cardiac Surgery: An Analysis of Risk Factors and Outcome according to the Type of Operation

2010 ◽  
Vol 13 (4) ◽  
pp. E212-E217 ◽  
Author(s):  
Fevzi Toraman ◽  
Sahin Senay ◽  
Umit Gullu ◽  
Hasan Karabulut ◽  
Cem Alhan
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Fast Track
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