RT Journal Article
SR Electronic
T1 Double Lumen Endotracheal Tube for Percutaneous Tracheostomy
JF Respiratory Care
FD American Association for Respiratory Care
SP 1652
OP 1659
DO 10.4187/respcare.03161
VO 59
IS 11
A1 Maria Vargas
A1 Giuseppe Servillo
A1 Gaetano Tessitore
A1 Fulvio Aloj
A1 Iole Brunetti
A1 Enrico Arditi
A1 Dorino Salami
A1 Robert M Kacmarek
A1 Paolo Pelosi
YR 2014
UL http://rc.rcjournal.com/content/59/11/1652.abstract
AB BACKGROUND: Percutaneous dilational tracheostomy is normally a bronchoscope-guided procedure. The insertion of a bronchoscope into an endotracheal tube (ETT) affects resistance, flow, and alveolar pressure. To improve airway management and ventilation during percutaneous tracheostomy, we developed a double lumen endotracheal tube (DLET). The aim of this in vitro study was to compare the linear constant of the Rohrer equation (K1), the nonlinear constant of the Rohrer equation (K2), the inspiratory and expiratory airway resistance, and ventilatory and airway pressures using the DLET with different standard sized ETTs. METHODS: A trachea and lung model was used to compare the DLET to ETTs with 7, 7.5, and 8 mm inner diameters with and without a bronchoscope (4.5 mm external diameter), and 4 and 5 mm inner diameter ventilation tubes (F4, F5) of a translaryngeal tracheostomy. For each device, the pressure drop across the device and the Rohrer equation linear constant (K1) and nonlinear constant (K2) were calculated during a continuous flow of 10–90 L/min, the inspiratory and expiratory airway resistance values were calculated during volume controlled mechanical ventilation, and respiratory airway pressure values were calculated during volume and pressure controlled mechanical ventilation. RESULTS: DLET had lower K2, pressure drop, and inspiratory and expiratory airway resistance compared with conventional ETTs plus fiberoptic bronchoscope. Furthermore, during mechanical ventilation, DLET had a lower value of peak pressure, mean pressure, and intrinsic PEEP than the other ETTs plus fiberoptic bronchoscope. CONCLUSIONS: Use of the DLET during percutaneous dilational tracheostomy allows fiberoptic bronchoscopy without imposing excessive airway resistance. Reduced tube resistance during this procedure may confer additional safety in what is well known to be a hazardous procedure.