Endotracheal Tubes Cleaned With a Novel Mechanism for Secretion Removal: A Randomized Controlled Clinical Study
Riccardo Pinciroli, Cristina Mietto, Annop Piriyapatsom, Christopher T Chenelle, John G Thomas, Massimiliano Pirrone, Lynn Bry, Gregory R Wojtkiewicz, Matthias P Nahrendorf, Robert M Kacmarek and Lorenzo Berra
Respiratory Care November 2016, 61 (11) 1431-1439; DOI: https://doi.org/10.4187/respcare.04363
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
A schematic representation of the endOclear device. A: A full view of the device, from the handle, to the central tube (45.7 cm, size 3.2 mm), to the cleaning apparatus. Note the red safety toggle and the blue stop, which can be positioned on the appropriate centimeter marking to avoid over-insertion. B: Insertion of the endOclear into an endotracheal tube. Detailed view of device activation from the collapsed (C) to radially-expanded configuration (D). The wiper disc diameter expands from 4.5 mm to approximately 9.4 mm once deployed. Secretions are cleared from the endotracheal tube lumen by withdrawing the expanded device.
A: High-resolution computed tomography (HRCT) spatial analysis. The endotracheal tube was first analyzed as a whole to collect data about the total mucus volume (mL), and the overall occlusion % (total mucus/(mucus + air)). The single slice showing the highest degree of luminal narrowing was also identified and studied to detect the maximum occlusion % (B). Assuming uniform mucus distribution, its measured cross-sectional area (CSA; cm2) was then approximated to that of a circle (C), in order to estimate the endotracheal tube lumen actually available to airflow (minimum internal diameter, mm = ). The Murphy-eye and the beveled edge of the tip of the endotracheal tube (terminal 16mm) were excluded from HRCT analysis due to the incompletely circular cross-section, causing artifacts in the volumetric computation. Sample representative HRCT mid-sagittal (D) and transversal (E) endotracheal tube scans are also shown. CSA = cross-sectional area.
Slice-by-slice mean luminal occlusion due to mucus accumulation along scanned endotracheal tubes (ETT) from lung (0 cm) to oral (22 cm) end. Data from 0 to 1.6 cm are intentionally omitted as described in the Methods section.