0
Editorials |

The Patient-Ventilator Interaction Has a Third Player: The Endotracheal Tube

Theodoros Vassilakopoulos, MD
Author and Funding Information

Affiliations: Dr. Vassilakopoulos is Associate Professor, Department of Critical Care and Pulmonary Services, University of Athens Medical School.

Correspondence to: Theodoros Vassilakopoulos MD, Associate Professor, Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, 45-47 Ipsilandou St, 10675 Athens, Greece; e-mail: tvassil@med.uoa.gr


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(4):957-959. doi:10.1378/chest.09-1032
Text Size: A A A
Published online

Extract

During invasive mechanical ventilation, physicians usually concentrate on treating the patient's underlying lung disease and adjusting the ventilator in such a way that it does not cause harm (eg, ventilator-induced lung injury, pneumothorax, or hemodynamic compromise) and delivers flow or pressure with such timing and magnitude that it matches the output of the patient's respiratory controller. Quite often, physicians forget that in this patient-ventilator interaction, there is a third player present: the artificial airway. Only after several days in the ICU, is the artificial airway considered as a potential source of trouble. In this issue of CHEST (see page 1006), Wilson et al1 challenge this view. In the laboratory, they measured the resistance (ie, the pressure drop at three different constant flow rates) of 71 endotracheal tubes immediately after being removed from ICU patients and that of a similar number of new tubes of equal size (internal diameter range, 7 mm to 8.5 mm). They found that three-quarters of the patients' endotracheal tubes had pressure drops of > 3 SDs of size-matched controls. In one-half of the extubated tubes, the resistance was equivalent to the next smaller size of new tubes, and in 10 to 15% of extubated tubes, to three sizes smaller. More importantly, the pressure drop was not related to the duration of intubation.1

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543