If you are experiencing problems downloading PDF or HTML fulltext, our helpdesk recommend clearing your browser cache and trying again. If you need help in clearing your cache, please click here . Still need help? Email help@ingentaconnect.com

Different Tracheotomy Tube Diameters Influence Diaphragmatic Effort and Indices of Weanability in Difficult to Wean Patients

The full text article is not available for purchase.

The publisher only permits individual articles to be downloaded by subscribers.

Abstract:

OBJECTIVE: To determine the effects of different tracheotomy tube sizes on diaphragm effort and weanability indices. METHODS: Ten tracheotomized and difficult to wean subjects were randomized to 2 T-piece trials, with different tracheotomy tube diameters: inner diameters 8 mm and 6.5 mm. Diaphragm pressure-time product per min. (PTPdi/min), lung compliance and resistance (CL and RL), breathing pattern, tension-time index of the diaphragm (TTdi), and the ratio of breathing frequency to tidal volume (f/VT) were recorded. In an in vitro model, the flow-pressure relationship was measured using the 2 tracheotomy tubes and 2 endotracheal tubes of the same diameter. RESULTS: The use of a smaller diameter resulted in an increase of PTPdi (337.63 ± 194.35 cm H2O · s/min vs 263.28 ± 156.23 cm H2O · s/min for 6.5 mm and 8 mm, respectively, P = .004) and RL (16.74 ± 8.10 cm H2O · s/min vs 11.72 ± 7.88 cm H2O · s/min, respectively, P = .008). Both weanability indices were also significantly higher using the smaller tube: f/VT 93.32 ± 20.91 vs 77.06 ± 19.26 for 6.5 mm and 8 mm, respectively, P < .02; TTdi 0.09 ± 0.052 vs 0.08 ± 0.04, respectively, P < .02. In vitro measurements confirmed that the resistances were higher with the smaller diameter and similar between the tracheotomy tubes and the endotracheal tubes of the same diameters. CONCLUSIONS: In tracheotomized difficult to wean subjects the decrease of the tracheotomy tube size was associated with an increased PTPdi, f/VT, and TTdi, that were otherwise normal, using a higher diameter. The in vitro study showed that the resistances increased similarly for tracheotomy tube and endotracheal tube, decreasing the diameter and increasing the flows.

Keywords: diaphragm; endotracheal tube; mechanical ventilation; ventilator dependence

Document Type: Research Article

DOI: http://dx.doi.org/10.4187/respcare.01747

Affiliations: Pneumologia e Terapia Intensiva Respiratoria, Azienda Opedaliera Universitaria Sant Orsola-Malpighi, Bologna, Italy

Publication date: December 1, 2012

More about this publication?
Related content

Tools

Favourites

Share Content

Access Key

Free Content
Free content
New Content
New content
Open Access Content
Open access content
Subscribed Content
Subscribed content
Free Trial Content
Free trial content
Cookie Policy
X
Cookie Policy
ingentaconnect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more