There are significant risks associated with intubation and mechanical ventilation in all populations,1,2 more so in patients with certain conditions such as status asthmaticus.3 With intubation, there is a transition from spontaneous breathing through the anatomic airway typically combined with mechanical breathing at supraphysiologic flow through a narrowed artificial airway causing an immediate substantial increase in airways resistance of the upper airway.4 In the patient with asthma, this effect compounds the preexisting elevated airways resistance stemming from inherent airway inflammation, increased mucus accumulation, and bronchospasm.5 Particularly challenging in this patient population is the current lack of standardization for the selection of a proper endotracheal tube (ETT) size prior to initiating invasive mechanical ventilation. Although studies have attempted to elucidate various ETT sizing recommendations and guidelines,6,7 there remains no consensus for ETT selection in any adult population.
In this issue of Respiratory Care, Kashiouris et al8 specifically evaluated the association between ETT size and mortality in subjects with status asthmaticus. They evaluated the most common adult ETT sizes used in current practice and concluded that the mortality rate was higher in subjects with status asthmaticus that were intubated with smaller ETTs. Specifically, in subjects intubated with ETT size ≤ 7.0 mm internal …
Correspondence: Tim W Gilmore PhD RRT RRT-NPS RRT-ACCS CPFT AE-C, Louisiana State University Health Shreveport, School of Allied Health Professions, 1450 Claiborne Ave, Shreveport, LA 71103. E-mail: tim.gilmore{at}lsuhs.edu
