| Potential Inadequacy of Automatic Tube Compensation to Decrease Inspiratory Workload After at Least 48 Hrs of Endotracheal Tube Use in the Clinical Setting. | |
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MedLine Citation:
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PMID: 22153219 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Endotracheal tubes (ETT) impose a significant respiratory workload on mechanically ventilated patients. Automatic tube compensation (ATC) should overcome this flow-dependent resistive workload; however, ETT resistance can be increased by tracheal secretions or ETT deformities. Our bench study investigated whether ATC provides effective respiratory workload relief in used ETTs. METHODS: Twenty critically ill patients requiring mechanical ventilation for longer than 48 h were enrolled. After extubation, we collected the used ETTs and measured the pressure-time products (PTP) 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 positive end-expiratory pressure (PEEP) of 5 cmH₂O, and fraction of inspired oxygen ratio of 0.21. The flow and airway pressure at the proximal (Paw) and distal (Ptra) ends of the ETT were recorded and the PTP integrated from Ptra 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 workload. ETT configuration changes and tracheal secretions can increase ETT resistance and decrease the ability of ATC to compensate for the increased respiratory workload. |
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Authors:
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Jun Oto; Hideaki Imanaka; Emiko Nakataki; Rie Ono; Masaji Nishimura |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-12-6 |
Journal Detail:
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Title: Respiratory care Volume: - ISSN: 0020-1324 ISO Abbreviation: - Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-12-13 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7510357 Medline TA: Respir Care Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
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