Model-based detection of partially obstructed endotracheal tube*

Visaria, Rachana K.; Westenskow, Dwayne R.

doi:10.1097/01.ccm.0000150656.01906.9f

Cited by 14 publications

(3 citation statements)

References 26 publications

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“…The use of inner sleeved tracheostomies is recommended to reduce blockage rates [12], however, our study does not allow us to determine if these tubes should have been used more often. Improvements in ventilator technology may also help in the diagnosis of blocked tubes [27]. Air leaks around tracheal tubes were often caused by accidental damage to the pilot tube, a situation which occasionally went on to harm patients.…”

Section: Discussionmentioning

confidence: 99%

Patient safety incidents associated with airway devices in critical care: a review of reports to the UK National Patient Safety Agency

Thomas¹,

2009

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SummaryWe used key words and letter sequences to identify airway-associated patient safety incidents submitted to the UK National Patient Safety Agency from critical care units in England and Wales. We identified 1085 such airway incidents submitted in the two years from October 2005 to September 2007. Three hundred and twelve incidents (28.8%) involved neonates or babies. Of the total 1085 incidents, 200 (18.4%) were associated with tracheal intubation, 53 (4.9%) with tracheostomy and 893 (82.3%) were post-procedure problems. One hundred and ten incidents (10.1%) were associated with more than temporary harm. Eighty-eight intubation incidents were associated with equipment problems. Partial displacement of tubes resulted in more than temporary harm to the patient more frequently than complete tube displacement (15.7% vs 3.8%). Capnography was not described in any cases of displacement or blockage of tracheal or tracheostomy tubes. Recommendations concerning minimum standards for capnography, availability and checking of equipment and tracheostomy placement are made.

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Section: Discussionmentioning

confidence: 99%

Patient safety incidents associated with airway devices in critical care: a review of reports to the UK National Patient Safety Agency

Thomas¹,

2009

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“…Acoustic reflection methods and pressure oscillation analyses have been proposed as alternative methods [9,10], and although they have potential, these methods require specialized equipment. Changes in expiratory time constants, which can be calculated from flow-volume curves, are another good indicator for detecting a partial obstruction [7,8,11]. Expiratory time constants are higher in obstructed compared to unobstructed tubes.…”

Section: Introductionmentioning

confidence: 99%

Sound Analysis in anIn VitroEndotracheal Tube Model

Park

Kee

Park

et al. 2011

Korean J Intern Med

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Background/AimsComplete endotracheal tube obstruction is a medical emergency, and partial occlusion causes increased breathing rates and failure to wean off mechanical ventilation. Partial occlusion may be underestimated due to the lack of proper detection methods. We tested whether the sound of an endotracheal tube could be used to detect an endotracheal tube obstruction using an in vitro model.MethodsAn endotracheal tube was connected to a ventilator on one end and a test lung on the other. Sounds were recorded with a microphone located inside the endotracheal tube via a connector. During mechanical ventilation, we changed the endotracheal tube internal diameter from 5.0 to 8.0 mm and different grades of obstruction at different sites were used along the tube. Sound energy was compared among the different conditions.ResultsThe energy of endotracheal tube sounds was positively correlated with the internal diameter and negatively correlated with the degree of obstruction. The rate of decline in energy differed with obstruction location. When the obstruction was more distal, the rate of decline in endotracheal sound energy was more rapid.ConclusionsChanges in the sound of an endotracheal tube can be used to detect an obstruction. Further studies are needed for clinical application.

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“…lthough airway secretion retention is a serious clinical problem that has attracted clinical and investigational interest throughout the past century, its incidence and relative importance in medical practice have been accentuated in the current era of mechanical ventilation (1)(2)(3)(4)(5). Central airway mucus plugging (CMP) represents one extreme on the spectrum of airway secretion retention and can be defined as unusually thickened mucus that at least transiently occludes (plugs) main or lobar bronchi through one or both phases of the breathing cycle.…”

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confidence: 99%