Ex Vivo Evaluation of Secretion-Clearing Device in Reducing Airway Resistance within Endotracheal Tubes
Background. Secretions accumulate in endotracheal tubes’ (ETT) lumens upon their placement in patients. The secretions impact airway resistance and pressure. Secretions potentiate prolonged mechanical ventilation and ventilator-associated pneumonia. Our primary objective in this study was to evaluat...
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Wiley
2018-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2018/3258396 |
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| author | Christopher Waters R. Constance Wiener Hamed M. Motlagh |
| author_facet | Christopher Waters R. Constance Wiener Hamed M. Motlagh |
| author_sort | Christopher Waters |
| collection | DOAJ |
| description | Background. Secretions accumulate in endotracheal tubes’ (ETT) lumens upon their placement in patients. The secretions impact airway resistance and pressure. Secretions potentiate prolonged mechanical ventilation and ventilator-associated pneumonia. Our primary objective in this study was to evaluate an ETT-clearing device (ETT-CD) in its ability to remove secretions from ex vivo ETT lumens. Methods. Forty ETTs, obtained from intensive care patients at extubation, were individually placed into a ventilator field performance testing simulator at 37°C. The pressure drop through the ETTs was measured at a flow rate of 60 L/min before and after cleaning with the ETT-CD and compared with unused, similarly sized controls tubes. The ETT-CD was inserted into an ETT until the tip reached Murphy’s eye (hole in the side) of the ETT. The wiper, set back from the tip, was expanded by ETT-CD handle activation. As the ETT-CD was removed, the distal wiper extracted secretions from the ETT lumen. Results. Forty ETTs were tested with nonparametric Wilcoxon signed-rank tests. Before being cleared with the ETT-CD, the median pressure drop in the extubated 7.5 mm ETTs was 17.8 cm H2O; after ETT-CD use, it was 12.3. The cleared ETTs were significantly improved over the ETTs before being cleared (p<0.001); however, there remained a significant difference between the cleared ETTs and the control tubes (p=0.005), indicating the clearing was not to the level of an unused ETT. Similar results were determined for the 8.0 mm ETTs. Conclusions. For the 7.5 mm and the 8.0 mm EETs, the ETT-CD improved effective patency of the ETTs over the uncleared ETTs, independent of occlusion location, tube size, or length of tube. However, there remained a significant difference between the cleared tubes and controls. |
| format | Article |
| id | doaj-art-a461ba6b12284d1d9e8f370f87d4b2b1 |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
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| series | Critical Care Research and Practice |
| spelling | doaj-art-a461ba6b12284d1d9e8f370f87d4b2b12025-02-03T06:44:31ZengWileyCritical Care Research and Practice2090-13052090-13132018-01-01201810.1155/2018/32583963258396Ex Vivo Evaluation of Secretion-Clearing Device in Reducing Airway Resistance within Endotracheal TubesChristopher Waters0R. Constance Wiener1Hamed M. Motlagh2Department of Dental Research, West Virginia University, Health Sciences Addition Room 106a, PO Box 9448, Morgantown, WV 26506, USADental Practice and Rural Health, West Virginia University, Health Sciences Addition Room 104a, PO Box 9448, Morgantown, WV 26506, USASchool of Dentistry, West Virginia University, Morgantown, WV, USABackground. Secretions accumulate in endotracheal tubes’ (ETT) lumens upon their placement in patients. The secretions impact airway resistance and pressure. Secretions potentiate prolonged mechanical ventilation and ventilator-associated pneumonia. Our primary objective in this study was to evaluate an ETT-clearing device (ETT-CD) in its ability to remove secretions from ex vivo ETT lumens. Methods. Forty ETTs, obtained from intensive care patients at extubation, were individually placed into a ventilator field performance testing simulator at 37°C. The pressure drop through the ETTs was measured at a flow rate of 60 L/min before and after cleaning with the ETT-CD and compared with unused, similarly sized controls tubes. The ETT-CD was inserted into an ETT until the tip reached Murphy’s eye (hole in the side) of the ETT. The wiper, set back from the tip, was expanded by ETT-CD handle activation. As the ETT-CD was removed, the distal wiper extracted secretions from the ETT lumen. Results. Forty ETTs were tested with nonparametric Wilcoxon signed-rank tests. Before being cleared with the ETT-CD, the median pressure drop in the extubated 7.5 mm ETTs was 17.8 cm H2O; after ETT-CD use, it was 12.3. The cleared ETTs were significantly improved over the ETTs before being cleared (p<0.001); however, there remained a significant difference between the cleared ETTs and the control tubes (p=0.005), indicating the clearing was not to the level of an unused ETT. Similar results were determined for the 8.0 mm ETTs. Conclusions. For the 7.5 mm and the 8.0 mm EETs, the ETT-CD improved effective patency of the ETTs over the uncleared ETTs, independent of occlusion location, tube size, or length of tube. However, there remained a significant difference between the cleared tubes and controls.http://dx.doi.org/10.1155/2018/3258396 |
| spellingShingle | Christopher Waters R. Constance Wiener Hamed M. Motlagh Ex Vivo Evaluation of Secretion-Clearing Device in Reducing Airway Resistance within Endotracheal Tubes Critical Care Research and Practice |
| title | Ex Vivo Evaluation of Secretion-Clearing Device in Reducing Airway Resistance within Endotracheal Tubes |
| title_full | Ex Vivo Evaluation of Secretion-Clearing Device in Reducing Airway Resistance within Endotracheal Tubes |
| title_fullStr | Ex Vivo Evaluation of Secretion-Clearing Device in Reducing Airway Resistance within Endotracheal Tubes |
| title_full_unstemmed | Ex Vivo Evaluation of Secretion-Clearing Device in Reducing Airway Resistance within Endotracheal Tubes |
| title_short | Ex Vivo Evaluation of Secretion-Clearing Device in Reducing Airway Resistance within Endotracheal Tubes |
| title_sort | ex vivo evaluation of secretion clearing device in reducing airway resistance within endotracheal tubes |
| url | http://dx.doi.org/10.1155/2018/3258396 |
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