Comparison of the effects of two humidifier systems on endotracheal tube resistance

Morán, Indalecio; Cabello, Belén; Manero, Elizabeth; Mancebo, Jordi

doi:10.1007/s00134-011-2351-9

Cited by 20 publications

(18 citation statements)

References 36 publications

(69 reference statements)

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“…Another study based on ETT air flow resistance after extubation showed that ETT narrowing was associated with the duration of ventilation, without statistical differences between 2 humidifier devices. 27 Shah and Kollef 28 found a 10% intraluminal volume loss increased with prolonged tracheal intubation, even if measurements were performed up to 5 d after extubation. In a subsequent study, Wilson et al 29 showed a large degree of resistance, occurring in all sizes of ETT, unpredictable regarding the duration of intubation, and beginning immediately in some subjects.…”

Section: Discussionmentioning

confidence: 97%

Description and Microbiology of Endotracheal Tube Biofilm in Mechanically Ventilated Subjects

Danin¹,

Girou²,

Legrand³

et al. 2014

Respir Care

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BACKGROUND: A biofilm is found on the inner side of endotracheal tubes (ETT) in mechanically ventilated patients, but its features and role in pneumonia remain unclear. METHODS: This prospective, observational, monocentric study included critically ill ventilated subjects. Measurement of the ETT inner volume was first performed before extubation using the acoustic reflection method. After extubation, the biofilm was studied by means of optical and atomic force microscopy. Bacteriological analysis was then performed and compared with clinical documentation. RESULTS: Twenty-four subjects were included. Duration of intubation lasted from 2 to 79 d (mean ؎ SD: 11 ؎ 15 d). The mean percentage of ETT volume loss evaluated in situ (n ‫؍‬ 21) was 7.1% and was not linked with the duration of intubation. Analyses with atomic force microscopy (n ‫؍‬ 6) showed a full coverage of the inner part of the tube with biofilm, even after saline rinse. Its thickness ranged from 0.8 to 5 m. Bacteriological cultures of the biofilm (n ‫؍‬ 22) often showed the same bacteria as in tracheal secretions, especially for pathogenic organisms. Pseudomonas aeruginosa and Candida albicans were among the most frequent microorganisms. In subjects who had experienced a successfully treated episode of ventilator-associated pneumonia (n ‫؍‬ 5), the responsible bacteria were still present in the biofilm. CONCLUSIONS: ETT biofilm is always present in intubated patients whatever the duration of intubation and appears quickly after intubation. Even after soft rinse, a small but measurable part of biofilm remains always present, and seems strongly adherent to the ETT lumen. It contains potentially pathogenic bacteria for the lung.

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Section: Discussionmentioning

confidence: 97%

Description and Microbiology of Endotracheal Tube Biofilm in Mechanically Ventilated Subjects

Danin¹,

Girou²,

Legrand³

et al. 2014

Respir Care

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“…inspissated secretions, others) increases airflow resistance and thus the effort to breathe. Data indicate that the airflow resistance of endotracheal tubes at the time of extubation is much higher than at the time of intubation, thus increasing the respiratory muscle work 15 . The optimal duration of the SBT trial is at least 30 minutes and no more than 120 minutes.…”

Section: Weaning Processmentioning

confidence: 98%

“…The deterioration in respiratory system mechanics in patients who fail the weaning trial is characterized by an increase in intrinsic positive end-expiratory pressure (PEEP), and inspiratory resistance with a decrease in dynamic lung compliance 22 . Physicians must take into account that the components of the ventilator circuit, including endotracheal tubes (size, deposit of secretions, curvatures, humidifiers), can increase resistance to airflow and the resistive component of the work of breathing in patients breathing spontaneously 15,23 .…”

Section: Respiratory Pump Failurementioning

confidence: 99%

The Process of Weaning from Mechanical Ventilation

Aguirre-Bermeo¹,

Mancebo²

2016

BRN

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Mechanical ventilation is a common process in intensive care units. The weaning period has to be initiated as soon as possible because a delay in recognition that weaning can begin may prolong the duration of mechanical ventilation unnecessarily. The inappropriate management of weaning could influence outcomes; therefore, patients on weaning require continuous attention and intervention. The main objective of this review is to provide a description of the entire scenario and update on outcomes and common recommendations for the correct management of this complex process. The role of modern ventilator modes and non-invasive mechanical ventilation are discussed. Finally, the description and outcomes of a group of patients who have poor outcomes (prolonged weaning group), the importance of their identification, and suggestions for their general management are also presented. (BRN Rev. 2016;2:185-97)

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“…3 A recent study by Moran et al showed that endotracheal tube resistance increased by 53% after a mean of 10 days of mechanical ventilation. 4 This study included 22 patients with heat and moisture exchangers (HMEs) and 22 patients with heated humidifier, and similar increases in resistance were present in both groups, demonstrating that, even with the latest generations of heated humidifiers and HMEs, optimal humidification may not be attained.…”

mentioning

confidence: 89%

“…3 Its other limitation is that it is somewhat cumbersome and is intended only for research. Considering that optimal humidity is still not provided to mechanically ventilated patients, 4 reliable surrogates of humidity should be developed. We are still looking for simple techniques to measure humidity during daily practice.…”

Section: See the Original Studies On Pages 1442 And 1449mentioning

confidence: 99%

Assessment of Humidification Performance: Still No Easy Method!

Cuquemelle

Lellouche

2013

Respir Care

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Comparison of the effects of two humidifier systems on endotracheal tube resistance

Abstract: 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.

Cited by 20 publications

References 36 publications

Description and Microbiology of Endotracheal Tube Biofilm in Mechanically Ventilated Subjects

Description and Microbiology of Endotracheal Tube Biofilm in Mechanically Ventilated Subjects

The Process of Weaning from Mechanical Ventilation

Assessment of Humidification Performance: Still No Easy Method!

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