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Research ArticleOriginal Research

An Artificial Cough Maneuver to Remove Secretions From Below the Endotracheal Tube Cuff

Alberto Zanella, Gaetano Florio, Emanuele Rezoagli, Martina Pastore, Paolo Cadringer, Osvaldo Biancolilli, Eleonora Carlesso, Vittorio Scaravilli, Giuseppe Ristagno and Antonio M Pesenti
Respiratory Care January 2019, respcare.06076; DOI: https://doi.org/10.4187/respcare.06076
Alberto Zanella
Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda – Ospedale Maggiore Policlinico, Milan, Italy.
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  • For correspondence: [email protected]
Gaetano Florio
Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
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Emanuele Rezoagli
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
Lung Biology Group, Regenerative Medicine Institute at CÚRAM Centre for Research in Medical Devices and the Discipline of Anaesthesia at the National University of Ireland, Galway, Ireland
Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, SAOLTA University Health Group, Galway, Ireland.
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Martina Pastore
Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
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Paolo Cadringer
Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
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Osvaldo Biancolilli
Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda – Ospedale Maggiore Policlinico, Milan, Italy.
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Eleonora Carlesso
Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
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Vittorio Scaravilli
Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda – Ospedale Maggiore Policlinico, Milan, Italy.
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Giuseppe Ristagno
IRCCS–Istituto di Ricerche Farmacologiche “Mario Negri” Milan, Italy.
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Antonio M Pesenti
Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda – Ospedale Maggiore Policlinico, Milan, Italy.
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Abstract

BACKGROUND: Endotracheal suctioning is mandatory to prevent complications caused by the retention of tracheal secretions. Endotracheal suctioning is often performed late, when patients show signs of respiratory and hemodynamic alterations. We conceived a prototype device that, when synchronized with the ventilator, automatically removes secretions collected below the endotracheal tube (ETT) cuff, thus avoiding endotracheal suctioning. The aim of our investigation was to assess the performance of this novel prototype in vitro.

METHODS: Three studies were performed to examine the characteristics of the prototype. We tested device's ability to generate an effective artificial cough flow (artificial cough maneuver) \g 1 L/s by rapidly deflating the ETT cuff within the time of a sustained inflation (at 30 and at 40 cm H2O) (cough flow study). We also tested the prototype's ability to remove the fluid positioned below the ETT cuff using saline dye (fluid removal study), and to prevent the aspiration of saline dye from above the ETT cuff during the deflation phase of the ETT cuff (aspiration study). The trachea model was positioned at 45|SD in the aspiration study, and horizontally in the other two studies.

RESULTS: In the cough flow study, the prototype provided an effective artificial cough maneuver, with a mean ± SD of 1.78 ± 0.19 L/s (range, 1.42–2.14 L/s). The tracheal pressure after ETT cuff deflation never decreased below the PEEP level. In the fluid removal study, the prototype cleared the fluid from below the ETT cuff and the experimental trachea. No fluid was aspirated from the area above the ETT cuff toward the lower airways.

CONCLUSIONS: We conceived an system capable of automatically expelling fluid from below the ETT cuff outside an experimental trachea by generating an artificial cough maneuver. This system may decrease the use of endotracheal suctioning and its complications. Future in vivo studies are needed to confirm this first in vitro evaluation.

  • cough
  • ventilator-associated pneumonia
  • mechanical ventilation
  • intubation
  • in vitro

Footnotes

  • Correspondence: Alberto Zanella, Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda – Ospedale Maggiore Policlinico, Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Via Francesco Sforza 35, Milan 20122, Italy. E-mail: alberto.zanella1{at}unimi.it.
  • The other authors have disclosed no conflicts of interest.

  • Copyright © 2019 by Daedalus Enterprises
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Respiratory Care: 66 (1)
Respiratory Care
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An Artificial Cough Maneuver to Remove Secretions From Below the Endotracheal Tube Cuff
Alberto Zanella, Gaetano Florio, Emanuele Rezoagli, Martina Pastore, Paolo Cadringer, Osvaldo Biancolilli, Eleonora Carlesso, Vittorio Scaravilli, Giuseppe Ristagno, Antonio M Pesenti
Respiratory Care Jan 2019, respcare.06076; DOI: 10.4187/respcare.06076

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An Artificial Cough Maneuver to Remove Secretions From Below the Endotracheal Tube Cuff
Alberto Zanella, Gaetano Florio, Emanuele Rezoagli, Martina Pastore, Paolo Cadringer, Osvaldo Biancolilli, Eleonora Carlesso, Vittorio Scaravilli, Giuseppe Ristagno, Antonio M Pesenti
Respiratory Care Jan 2019, respcare.06076; DOI: 10.4187/respcare.06076
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Keywords

  • cough
  • ventilator-associated pneumonia
  • mechanical ventilation
  • intubation
  • in vitro

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