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Potential Inadequacy of Automatic Tube Compensation to Decrease Inspiratory Work Load After at Least 48 Hours of Endotracheal Tube Use in the Clinical Setting

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BACKGROUND: Endotracheal tubes (ETTs) impose a substantial respiratory work load on mechanically ventilated patients. Automatic tube compensation (ATC) should overcome this flow-dependent resistive work load; however, ETT resistance can be increased by tracheal secretions or ETT deformities. Our bench study investigated whether ATC provides effective respiratory work load relief in used ETTs. METHODS: We enrolled 20 critically ill patients requiring mechanical ventilation for longer than 48 hours. After extubation, we collected the used ETTs and measured the pressure-time products (PTPs) by using a bellows-in-a-box lung model that simulated spontaneous breathing, at a respiratory rate of 10 breaths/min, inspiratory time of 1.0 s, and tidal volumes (VT) of 300 mL, 500 mL, and 700 mL. The ventilator was set at ATC 100% with PEEP of 5 cm H2O and FIO2 of 0.21. The flow and airway pressure at the proximal (Paw) and distal (Ptr) ends of the ETT were recorded, and the PTP integrated from Ptr analyzed. RESULTS: PTP values increased with VT during ATC. Even at 100% ATC the ventilator did not completely compensate for the PTP imposed by the ETT. In used ETTs, peak flow and peak Paw were lower and PTP values were greater than in new ETTs. As VT increased, the percentage difference in the PTP values between the new and used ETTs increased. CONCLUSIONS: ATC does not necessarily compensate for an ETT-imposed respiratory work load. ETT configuration changes and tracheal secretions can increase ETT resistance and decrease the ability of ATC to compensate for the increased respiratory work load.

Keywords: automatic tube compensation; endotracheal tube resistance; mechanical ventilation; pressure-time product; respiratory work load

Document Type: Research Article

DOI: http://dx.doi.org/10.4187/respcare.01380

Affiliations: Department of Emergency and Critical Care Medicine, The University of Tokushima Graduate School, Tokushima City, Japan

Publication date: May 1, 2012

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