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Research ArticleOriginal Research

Endotracheal Tube Size Is Associated With Mortality in Patients With Status Asthmaticus

Markos G Kashiouris, Christopher D Chou, Yub Raj Sedhai, Randy Bitrus, Matthew M Churpek, Casey Cable, Michael L’Heureux, Arjun Mohan and Curtis N Sessler
Respiratory Care March 2022, 67 (3) 283-290; DOI: https://doi.org/10.4187/respcare.09609
Markos G Kashiouris
Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia.
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  • For correspondence: [email protected]
Christopher D Chou
Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia.
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Yub Raj Sedhai
Department of Internal Medicine, Community Memorial Hospital, Virginia Commonwealth University, South Hill, Virginia.
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Randy Bitrus
Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia.
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Matthew M Churpek
Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin, Madison, Wisconsin.
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Casey Cable
Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia.
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Michael L’Heureux
Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia.
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Arjun Mohan
Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia.
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Curtis N Sessler
Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia.
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Abstract

BACKGROUND: There is limited evidence on the clinical importance of the endotracheal tube (ETT) size selection in patients with status asthmaticus who require invasive mechanical ventilation. We set out to explore the clinical outcomes of different ETT internal diameter sizes in subjects mechanically ventilated with status asthmaticus.

METHODS: This was a retrospective study of intubated and non-intubated adults admitted for status asthmaticus between 2014–2021. We examined in-hospital mortality across subgroups with different ETT sizes, as well as non-intubated subjects, using logistic and generalized linear mixed-effects models. We adjusted for demographics, Charlson comorbidities, the first Sequential Organ Failure Assessment score, intubating personnel and setting, COVID-19, and the first PaCO2. Finally, we calculated the post-estimation predictions of mortality.

RESULTS: We enrolled subjects from 964 status asthmaticus admissions. The average age was 46.9 (SD 14.5) y; 63.5% of the encounters were women and 80.6% were Black. Approximately 72% of subjects (690) were not intubated. Twenty-eight percent (275) required endotracheal intubation, of which 3.3% (32) had a 7.0 mm or smaller ETT (ETT ≤ 7 group), 16.5% (159) a 7.5 mm ETT (ETT ≤ 7.5 group), and 8.6% (83) an 8.0 mm or larger ETT (ETT ≥ 8 group). The adjusted mortality was 26.7% (95% CI 13.2–40.2) for the ETT ≤ 7 group versus 14.3% ([(95% CI 6.9–21.7%], P = .04) for ETT ≤ 7.5 group and 11.0% ([95% CI 4.4–17.5], P = .02) for ETT ≥ 8 group, respectively.

CONCLUSIONS: Intubated subjects with status asthmaticus had higher mortality than non-intubated subjects. Intubated subjects had incrementally higher observed mortality with smaller ETT sizes. Physiologic mechanisms can support this dose-response relationship

  • status asthmaticus
  • endotracheal tube size
  • diameter
  • airway resistance
  • mortality
  • dynamic hyperinflation

Footnotes

  • Correspondence: Markos G Kashiouris MD MPH, Division of Pulmonary and Critical Care, Virginia Commonwealth University, PO Box 980509, Richmond, VA 23298. E-mail: mkashiouris{at}vcu.edu
  • See the Related Editorial on Page 373

  • The authors have disclosed no conflicts of interest.

  • The study was supported by a VCU Wright Center for Translational Science Award (UL1TR000058), Division of Pulmonary Disease and Critical Care Medicine, VCU School of Medicine.

  • Copyright © 2022 by Daedalus Enterprises
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Respiratory Care: 67 (3)
Respiratory Care
Vol. 67, Issue 3
1 Mar 2022
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Endotracheal Tube Size Is Associated With Mortality in Patients With Status Asthmaticus
Markos G Kashiouris, Christopher D Chou, Yub Raj Sedhai, Randy Bitrus, Matthew M Churpek, Casey Cable, Michael L’Heureux, Arjun Mohan, Curtis N Sessler
Respiratory Care Mar 2022, 67 (3) 283-290; DOI: 10.4187/respcare.09609

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Endotracheal Tube Size Is Associated With Mortality in Patients With Status Asthmaticus
Markos G Kashiouris, Christopher D Chou, Yub Raj Sedhai, Randy Bitrus, Matthew M Churpek, Casey Cable, Michael L’Heureux, Arjun Mohan, Curtis N Sessler
Respiratory Care Mar 2022, 67 (3) 283-290; DOI: 10.4187/respcare.09609
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Keywords

  • status asthmaticus
  • endotracheal tube size
  • diameter
  • airway resistance
  • mortality
  • dynamic hyperinflation

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