“Narrow” Thinking About Difficult Weaning: Don't Forget the Endotracheal Tube

Epstein, Scott K.

doi:10.4187/respcare.02212

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…The proportion of cross-sectional area obstructed with a standard 5.7 mm bronchoscope was 55.8% of the cross-sectional area of a 7.0 mm tube, and thus a minimum endotracheal tube size of 7.5-8 mm internal diameter has been recommended to facilitate bronchial toilet in ICU patients 8 . In patients sensitive to increases in the work of breathing (WOB), small tracheal tube diameters may result in markedly higher resistance to gas flow resulting in greater WOB during ventilator weaning, and thus a larger tube size will reduce WOB and may be associated with more successful weaning 9,21,22 .…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Tracheal Diameter in Caucasian and Chinese Patients

Tai

Corke

Joynt

et al. 2016

Anaesth Intensive Care

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Ethnicity may be considered a factor when considering what size endotracheal tube to insert. In particular it has been suggested that Chinese patients have a smaller tracheal diameter, justifying the selection of smaller endotracheal tubes. We systematically evaluated transverse tracheal diameters in Chinese and Caucasian patients, utilising archived computer tomography images. A convenience sample of 100 Caucasian patients from Australia was compared with 100 Chinese patients from Hong Kong. Patients over 18 years of age who had undergone a computerised tomography scan of the neck and thorax, and also had accurate body height and weight recorded, were studied. The mean transverse diameter of the trachea measured at three levels was similar between the Chinese and Caucasian patients. At the narrowest measurement point, the immediate subcricoid transverse diameter, the unadjusted mean difference between male Chinese and Caucasian patients was small (1 mm, standard deviation 0.83 mm, P=0.01), and similarly small between female Chinese and Caucasian patients (1.5 mm, standard deviation 0.8 mm, P <0.01). Multivariate analysis demonstrated only a small influence related to ethnicity (12% relative contribution to the overall variance [R2] of the model), but substantial influence of height (40%) and sex (41%). Our findings do not support the practice of routinely selecting a smaller endotracheal tube size for Chinese patients on the basis that there is a difference related to the Chinese ethnic phenotype. Considerations regarding choice of endotracheal tube size should rather focus on patient sex and height.

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Section: Discussionmentioning

confidence: 99%

A Comparative Study of Tracheal Diameter in Caucasian and Chinese Patients

Tai

Corke

Joynt

et al. 2016

Anaesth Intensive Care

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“…Removing the biofilm and secretions within the ETT helps reduce the airway resistance and associated work of breathing and may be important in addressing ventilator weaning failure in certain patients. 186,187 An ETT Bundle?…”

Section: Subglottic Secretion Drainagementioning

confidence: 99%

Endotracheal Tubes: Old and NewDiscussion

et al. 2014

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The development and evolution of the endotracheal tube (ETT) have been closely related to advances in surgery and anesthesia. Modifications were made to accomplish many tasks, including minimizing gross aspiration, isolating a lung, providing a clear facial surgical field during general anesthesia, monitoring laryngeal nerve damage during surgery, preventing airway fires during laser surgery, and administering medications. In critical care management, ventilator-associated pneumonia (VAP) is a major concern, as it is associated with increased morbidity, mortality, and cost. It is increasingly appreciated that the ETT itself is a primary causative risk for developing VAP. Unfortunately, contaminated oral and gastric secretions leak down past the inflated ETT cuff into the lung. Bacteria can also grow within the ETT in biofilm and re-enter the lung. Modifications to the ETT that attempt to prevent bacteria from entering around the ETT include maintaining an adequate cuff pressure against the tracheal wall, changing the material and shape of the cuff, and aspirating the secretions that sit above the cuff. Attempts to reduce bacterial entry through the tube include antimicrobial coating of the ETT and mechanically scraping the biofilm from within the ETT. Studies evaluating the effectiveness of these modifications and techniques demonstrate mixed results, and clear recommendations for which modification should be implemented are weak.

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“Narrow” Thinking About Difficult Weaning: Don't Forget the Endotracheal Tube

Cited by 2 publications

References 23 publications

A Comparative Study of Tracheal Diameter in Caucasian and Chinese Patients

A Comparative Study of Tracheal Diameter in Caucasian and Chinese Patients

Endotracheal Tubes: Old and NewDiscussion

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