Abstract
Background: Previously no device existed to manage partial occlusions of the neonatal endotracheal tube (ETT). Suctioning with or without lavage could be used with potential consequences of the lavage. An ETT that is partially obstructed and causing difficult ventilation would require elective or emergent reintubation as the only option. A new device has been designed to clear the ETT lumen of secretions causing a partial obstruction. We wanted to determine if this new device could clean the neonatal ETT lumen after secretions had partially occluded the tube. Methods: A bench study was performed to test the new device (Restore Neonate, endOclear LLC) to clean neonatal ETTs. A Drager VN500 with pressure-controlled settings was connected to an ASL 5000 test lung via an ETT. Three sizes of ETTs were tested: 2.5, 3.0 and 3.5 with a sequence of 3 partial occlusions each. The occlusions were created with simulated mucus (a propylene glycol mixture that was colored blue and was within the published range of human mucus viscosity). The occlusions were created by depositing 0.25 to 0.75 mL of simulated mucus until there was a brief airway occlusion as noted on the ventilator. A single pass of the catheter was used to clear the ETT each time. Flow-volume loops as well as breath to breath resistance measurements from the ventilator were used to evaluate effectiveness of the device to clean the ETT lumen. Results: Average ventilator resistance measurements (cm H2O/L/s) from the 3 simulated occlusions for each of the ETT were as follows. Size 2.5 ETT resistance measurements: 130-new ETT, 175-partial ETT occlusion, 135-post ETT cleaning. Size 3.0 ETT resistance measurements: 106-new ETT, 206-partial ETT occlusion, 108-post ETT cleaning. Size 3.5 ETT resistance measurements: 87-new ETT, 190-partial ETT occlusion, 86-post ETT cleaning. See figure for a representative set of flow-volume loops for the new ETT, the partial occlusion and the ETT after cleaning. Conclusions: The Restore Neonate appears to have fully recovered the lumen of the neonatal ETT in our bench study with a partial occlusion of simulated mucus as evidenced by resistance measurement returning to values similar to the new ETT as well as the flow-volume loops returning to the same shape as the new ETT. This new device may be valuable for cleaning the ETT of neonates instead of having to reintubate when partial obstructions occur.
Flow-volume loops displaying: new ETT, simulated partial occlusion and after cleaning of the ETT
Footnotes
Commercial Relationships: John Emberger has accepted honoraria from Drager Medical and consulted for Mallinckrodt and GLG.
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