An in vitro evaluation of the influence of neonatal endotracheal tube diameter and length on the work of breathing

Miyake, Fuyu; Suga, Rika; Akiyama, Toru; Namba, Fumihiko

doi:10.1111/pan.13366

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…3 Clinicians frequently use PS to try to reduce the work of the breathing imposed on the baby by breathing through a narrow endotracheal tube. 6,7 In a randomized trial, infants ventilated with SIMV-PS required fewer days of mechanical ventilation than babies receiving SIMV only. 8 When using pressure-controlled SIMV-PS without VG, the relationship between the peak inflating pressure of SIMV inflations (PIP) and of pressure-supported spontaneous breaths (PIP PS = PEEP + PS) is constant and is determined by user settings.…”

Section: Introductionmentioning

confidence: 99%

“…The use of PS converts spontaneous breaths into pressure‐limited inflations; their inspiratory time (Ti) is variable because they are flow‐cycled rather than time‐cycled 3 . Clinicians frequently use PS to try to reduce the work of the breathing imposed on the baby by breathing through a narrow endotracheal tube 6,7 . In a randomized trial, infants ventilated with SIMV‐PS required fewer days of mechanical ventilation than babies receiving SIMV only 8 …”

Section: Introductionmentioning

confidence: 99%

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Synchronized intermittent mandatory ventilation with volume guarantee and pressure support in neonates: Detailed analysis of ventilator parameters

Balajthy

Balázs

Kovács

et al. 2023

Pediatric Pulmonology

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Objective: To analyse the relationship between peak inflating pressure, expired tidal volume, respiratory rate, and inspiratory time of volume-guaranteed ventilator inflations and pressure-supported spontaneous breaths during synchronized intermittent positive pressure mode with volume guarantee and pressure support (SIMV-VG-PS) in neonates.Methods: Ventilator parameters were downloaded every second from 16 babies ventilated with SIMV-VG-PS mode using Dräger Babylog VN500 ventilators over 137 days. Transcutaneous carbon dioxide (tcCO 2 ) data were also collected. Data were computationally analysed using Python. The average of each ventilator parameter was determined during each minute separately for ventilator inflations and for spontaneous breaths. These values were compared and their effect on tcCO 2 levels was also analysed. Results:The relationship between the peak inflating pressure of the volume guaranteed inflations (PIP VG ) and pressure-supported spontaneous breaths (PIP PS ) was highly variable. The PIP PS /PIP VG ratio differed significantly from the value (0.66) targeted by clinicians (group median: 0.80, range: 0.50-1.00). PIP PS frequently exceeded PIP VG . When PIP PS /PIP VG was >0.66, the expired tidal volume and the rate of the pressure-supported spontaneous breaths were also significantly (p < 0.0001) higher, but there was no difference in tcCO 2 levels. The flow-cycled spontaneous breaths had significantly shorter inspiratory times than ventilator inflations.Conclusions: During SIMV-VG-PS it is difficult to ensure a pressure support level proportionate to the inflating pressure of ventilator inflations and to achieve the stability of tidal volumes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Synchronized intermittent mandatory ventilation with volume guarantee and pressure support in neonates: Detailed analysis of ventilator parameters

Balajthy

Balázs

Kovács

et al. 2023

Pediatric Pulmonology

View full text Add to dashboard Cite

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Effectiveness of substantial shortening of the endotracheal tube for decreasing airway resistance and increasing tidal volume during pressure-controlled ventilation in pediatric patients: a prospective observational study

Takahashi

Toyama

Kubo

et al. 2023

J Clin Monit Comput

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Effectiveness of substantial shortening of the endotracheal tube for decreasing airway resistance and increasing tidal volume during pressure-controlled ventilation in pediatric patients: a prospective observational study

Takahashi

Toyama

Kubo

et al. 2022

Preprint

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Purpose: Anesthesiologists often shorten endotracheal tubes (ETTs) because the resistance of the ETT (RETT) is believed to be a major contributor to total airway resistance (Rtotal) in children intubated with ETTs of smaller inner diameter. However, the effectiveness of ETT shortening for mechanical ventilation in the clinical setting has not been reported. In this work, we performed a prospective clinical study and a laboratory experiment to assess the effectiveness of shortening a cuffed ETT for increasing tidal volume (TV) and decreasing Rtotal during constant pressure-controlled ventilation, and to estimate the RETT/Rtotal ratio in children. Method: In anesthetized children in a constant pressure-controlled ventilation setting, TV and Rtotal were measured with a pneumotachometer before and after shortening a cuffed ETT. The pressure gradient curves for the original length, shortened length, and the slip joint alone of the ETT were measured in vitro to determine the RETT/Rtotal ratio. Results: The clinical study included 22 children. The median ETT percent shortening was 21.7%. Median Rtotal was decreased from 26 to 24 cmH2O/L/s, and median TV was increased by 6% after ETT shortening. Additionally, approximately 40% of the pressure gradient across the ETT at its original length was generated by the slip joint. Median RETT and median RETT/Rtotal before ETT shortening were calculated as 17.7 cmH2O/L/s and 0.69, respectively. Conclusions: The increase in TV caused by ETT shortening was small because the resistance of the slip joint was very large, limiting the effectiveness of ETT shortening.

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An in vitro evaluation of the influence of neonatal endotracheal tube diameter and length on the work of breathing

Abstract: In our infant lung model, a shorter tube resulted in a lower work of breathing and lower ventilator-generated peak inspiratory pressure.

Cited by 3 publications

References 6 publications

Synchronized intermittent mandatory ventilation with volume guarantee and pressure support in neonates: Detailed analysis of ventilator parameters

Synchronized intermittent mandatory ventilation with volume guarantee and pressure support in neonates: Detailed analysis of ventilator parameters

Effectiveness of substantial shortening of the endotracheal tube for decreasing airway resistance and increasing tidal volume during pressure-controlled ventilation in pediatric patients: a prospective observational study

Effectiveness of substantial shortening of the endotracheal tube for decreasing airway resistance and increasing tidal volume during pressure-controlled ventilation in pediatric patients: a prospective observational study

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