Endotracheal tube occlusion associated with the use of heat and moisture exchangers in the intensive care unit

Il, Cohen; Pf, Weinberg; Ia, Fein; Gs, Rowinski

doi:10.1097/00003246-198803000-00013

Cited by 132 publications

(81 citation statements)

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“…This would be of particular benefit when using a heat and moisture exchanger, where unrecognized fluid accumulation and altered resistance can cause respiratory distress and associated complications. 6,8 Similar issues may apply for closed system suction devices. 16 Using Ptr to regulate ventilator pressure would also overcome the failure of FAV to take into account the prominent flow dependence of endotracheal tube resistance, and the resulting potential for the development of patient-ventilator asynchrony, frequent alarms, and the need for caregiver intervention and ventilator adjustments.…”

Section: Discussionmentioning

confidence: 95%

“…Substantial in vivo increases in tube resistance are frequent, often quite variable, and considerably increase patient effort during assisted modes of ventilation. [6][7][8][9] Respiratory system resistance is also highly flow dependent, primarily due to the flow resistive properties of the endotracheal tube. 7,10 Failure to take this into account during FAV may lead to under-assistance as well as over-assistance, resulting in patient-ventilator asynchrony, frequent alarms, and increased caregiver intervention.…”

Section: P Roportional Assist Ventilation (Pav) Is a Novel Mode Of Pamentioning

confidence: 99%

“…10 Moreover, even under optimal conditions ATC cannot compensate for the expected increase in endotracheal tube resistance that occurs in vivo due to secretions, tube deformation, or reduced airway patency for other reasons. 6,8,15,16 Investigators have demonstrated that direct recordings of tracheal pressure (Ptr) via an intraluminal catheter can be used to overcome in vivo values of endotracheal tube resistance during continuous positive airway pressure or pressure support ventilation. 10,17 We hypothesized that the limitations described above for PAV and ATC might be addressed by using Ptr rather than Pao to regulate the positive pressure applied during VAV alone without the addition of FAV.…”

Section: P Roportional Assist Ventilation (Pav) Is a Novel Mode Of Pamentioning

confidence: 99%

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Tracheal pressure regulated volume assist ventilation in acute respiratory failure

Mirkovic̆¹,

Paver-Eržen²,

Klokočovnik

et al. 2007

Can J Anesth/J Can Anesth

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Purpose: Proportional assist ventilation (PAV) uses volume assist (VAV) and flow assist ventilation (FAV) to reduce elastic and resistive effort, respectively. Proportional assist ventilation may be difficult to apply clinically, particularly due to FAV related considerations. It was hypothesized that regulating tracheal (Ptr) rather than airway opening pressure (Pao), to overcome endotracheal tube related resistive effort, during VAV would provide an effective alternative method of ventilation. We therefore compared the effects of Pao and Ptr regulated VAV on breathing pattern and inspiratory effort. Methods:In seven intubated patients, flow, volume, Pao, Ptr, esophageal and transdiaphragmatic pressure were measured during VAV (0-80% respiratory system elastance) using Pao vs Ptr to regulate ventilator applied pressure. Breathing pattern and the pressure-time integral of the inspiratory muscles (∫P mus ⋅dt) and diaphragm (∫P di ⋅dt) were determined.Results: Compared to spontaneous breathing, the respiratory rate to tidal volume ratio, or rapid shallow breathing index (RSBI), improved progressively with increasing VAV (130 ± 64 vs 70 ± 35, VAV 0 vs 80%; P < 0.05) while inspiratory effort fell (∫P mus ⋅dt = 39.6 ± 7.5 vs 28.5 ± 7.2 cm H 2 O·sec·L -1 , ∫P di ⋅dt, = 35.4 ± 7.8 vs 24.2 ± 5.9 cm H 2 O·sec·L -1 , VAV 0 vs 80%; P < 0.05) due to a decrease in elastic related effort. At any given level of support, there was further reduction in RSBI, ∫P mus ⋅dt, and ∫P di ⋅dt (which averaged 23.6 ± 2.7, 33.7 ± 4.4, and 38.5 ± 5.1%, respectively; P < 0.05) for Ptr compared to Pao regulated VAV due to a decrease in resistive effort. Conclusions:Tracheal pressure regulated VAV can be a simple and effective method of partial ventilatory support in acute respiratory failure. Further work will be needed to determine its efficacy and potential benefit relative to PAV and other modes of ventilation in routine clinical practice.

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Section: Discussionmentioning

confidence: 95%

Section: P Roportional Assist Ventilation (Pav) Is a Novel Mode Of Pamentioning

confidence: 99%

Section: P Roportional Assist Ventilation (Pav) Is a Novel Mode Of Pamentioning

confidence: 99%

See 1 more Smart Citation

Tracheal pressure regulated volume assist ventilation in acute respiratory failure

Mirkovic̆¹,

Paver-Eržen²,

Klokočovnik

et al. 2007

Can J Anesth/J Can Anesth

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“…The effects of inadequate humidification are known to increase with duration, 10 which may explain the differences in clinical events between the 20-hour and 10-week studies. It has been reported that in adults mechanically ventilated in the ICU there are fewer endotracheal tube occlusions with HH than with HME, [11][12][13][14][15] despite the fact that subjects with "thick" airway secretions were excluded from all trials. 16 In tracheostomized adult patients there has been one published long-term study of humidification, which compared HME to no treatment and found a decrease in the occurrence of pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Heated Humidification Improves Clinical Outcomes, Compared to a Heat and Moisture Exchanger in Children With Tracheostomies

et al. 2013

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BACKGROUND:The upper airway humidifies and warms inspired gases before they reach the trachea, a process bypassed by the insertion of a tracheostomy, necessitating humidification of inspired gases. The optimal method of humidification is not known. METHODS: We conducted a short-term 20-hour study and a long-term 10-week randomized crossover study comparing a heated humidifier (HH) to a heat and moisture exchanger (HME) in children with established tracheostomies. Subjects were assessed for clinical events, clinical examination findings, airway cytokine levels, and airway secretion viscoelasticity. RESULTS: For the short-term study, 15 children were recruited; for the long-term study, 14 children were recruited. Children using the HH had decreased respiratory examination score (P < .001) but no change in clinical events over the short term. There was a decrease in acute clinical events (P ‫؍‬ .008) in the long-term study. No differences were found in airway secretion viscoelasticity results or cytokine levels in either study, but these sample numbers were limited. CONCLUSIONS: Over 20 hours use, HH, compared to HME, improved work of breathing. Over a longer 10 week treatment period HH resulted in decreased adverse clinical events.

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“…Sus principales desventajas son que aumentan el espacio muerto instrumental y que se ha reportado una menor capacidad de humidificar y temperar el aire inspirado al comparár-seles con sistemas activos y de este modo pudiese significar un aumento en las complicaciones de la vía aérea. Los humidificadores activos son más efectivos para temperar y humidificar el gas inspirado, por lo que pueden asociarse a una menor probabilidad de obstrucción del tubo traqueal por secreciones 4,11 , y adicionalmente, no aumentan el espacio muerto instrumental, permitiendo un mejor manejo del CO 2 4,12 .…”

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Encuesta sobre humidificación de la vía aérea en unidades de cuidados intensivos de adultos de Chile

et al. 2012

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Endotracheal tube occlusion associated with the use of heat and moisture exchangers in the intensive care unit

Cited by 132 publications

References 0 publications

Tracheal pressure regulated volume assist ventilation in acute respiratory failure

Tracheal pressure regulated volume assist ventilation in acute respiratory failure

Heated Humidification Improves Clinical Outcomes, Compared to a Heat and Moisture Exchanger in Children With Tracheostomies

Encuesta sobre humidificación de la vía aérea en unidades de cuidados intensivos de adultos de Chile

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