TY - JOUR T1 - Corrective Measures for Compromised Oxygen Delivery During Endotracheal Tube Cuff Deflation With High-Frequency Percussive Ventilation JF - Respiratory Care SP - 271 LP - 277 VL - 52 IS - 3 AU - Patrick F Allan AU - Gregory Naworol Y1 - 2007/03/01 UR - http://rc.rcjournal.com/content/52/3/271.abstract N2 - OBJECTIVE: To determine the effect of endotracheal-tube cuff deflation on airflow and FIO2 during high-frequency percussive ventilation (HFPV), and explore methods of correcting the cuff-deflation-associated decrease in mean airway pressure and FIO2 at the carina. METHODS: Using a mechanical lung model in our respiratory research laboratory, we measured circuit pressure near the connection to the endotracheal tube (Pvent), mean airway pressure (P̄aw), pulsatile tidal volume (VT), and FIO2 at the artificial carina. During cuff deflation we manipulated the pulsatile frequency, pulsatile flow, and the HFPV integral nebulizer. We then assessed 4 methods of correcting the decreased FIO2 and airway pressure during cuff deflation: (1) oxygen delivery at the inspiratory fail-safe valve, (2) oxygen delivery at the T-piece between the HFPV and the endotracheal tube, (3) continuous activation of the HFPV's integral nebulizer, and (4) oxygen insufflation into the suction channel of the endotracheal tube. RESULTS: Cuff deflation reduced Pvent, P̄aw, pulsatile VT, and FIO2. Increasing the pulsatile flow and decreasing the pulsatile frequency further reduced FIO2 during cuff deflation. Injecting supplemental oxygen at the inspiratory fail-safe valve provided the best FIO2 increase. Injecting oxygen at the T-piece provided the second best FIO2 increase. Continuous activation of the integral nebulizer provided the third best FIO2 increase. Oxygen insufflation to the suction channel was least effective in correcting the FIO2 decrease caused by cuff deflation. CONCLUSION: Cuff-deflation-associated FIO2, P̄aw, and pulsatile VT compromise can be partially corrected by any of the 4 methods we studied. Injecting supplemental oxygen at the inspiratory fail-safe valve is the most effective method. ER -