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Laboratory and Animal InvestigationsHome Ventilator Low-Pressure Alarms Fail To Detect Accidental Decannulation With Pediatric Tracheostomy Tubes
Section snippets
Materials and Methods
Tracheostomy tube decannulation was simulated using sevendifferent tracheostomy tube (Bivona Medical Technologies; Gary, IN)sizes, ranging from an inner diameter (ID) of 3.0 to 6.0 mm. Thecircuit from a home ventilator (Aequitron LP-10; Mallinkrodt; Minneapolis, MN) was attached to the tracheostomy tubes that, in turn, were connected to a test lung (Siemens Test Lung 180; Siemens Elema AB; Solna, Sweden) using an appropriately sized endotracheal tube adapter.
Decannulation was simulated by
Results
With the LPA4, simulated decannulation with a tracheostomy tube of< 5.0-mm ID was not detected on the low and medium ventilatorsettings. The LPA4 failed to alarm on decannulation with a tracheostomytube of < 4.5-mm ID on the high ventilator settings (Table 1).
With the LPA10, simulated decannulation using the low ventilatorsettings was not detected with any of the tracheostomy tubes tested. The LPA10 failed to alarm on decannulation with all tracheostomy tubesexcept those with an ID of 6.0 mm on
Discussion
Our study shows that home ventilator low-inspiratory-pressurealarms do not sound during simulated decannulation with smalltracheostomy tubes. Although this possibility is mentioned in the, Aequitron LP-10 clinician's manual, it has not been verified and/orreported. Undetected low-pressure states place ventilator-dependentchildren at significant risk for hypoventilation and cardiopulmonaryarrest. The alarms may fail to sound because of the high resistanceinherent with small tracheostomy tubes.
Conclusion
In summary, we conclude that home ventilatorlow-inspiratory-pressure alarms frequently fail to detect simulateddecannulation with small tracheostomy tubes. This occurred regardlessof the low-inspiratory-pressure alarm setting. With the LPA10, decannulation was detected with nearly all tracheostomy tubes studied. With the LPA4, the detection of decannulation was slightlybetter. However, the LPA4 remained unable to detectdecannulation in tracheostomy tubes with an ID of < 5.0 mm. Therefore, we
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