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Original Research: CRITICAL CARE MEDICINE |

Increases in Endotracheal Tube Resistance Are Unpredictable Relative to Duration of Intubation

Alison M. Wilson, MD; Dana M. Gray; John G. Thomas, PhD
Author and Funding Information

Affiliations: From the Departments of Surgery (Dr. Wilson) and Pathology (Ms. Gray and Dr. Thomas), West Virginia University, Morgantown, WV.

Correspondence to: Alison Wilson, MD, Department of Surgery, Health Science Center, Suite 7300, Box 9238, West Virginia University, Morgantown, WV 26506; e-mail: awilson@hsc.wvu.edu


The study was performed at West Virginia University, School of Medicine and West Virginia University Hospitals, Morgantown, WV.

This project was supported in part by a grant from Covidien Healthcare, previously TYCO Healthcare/Nellcor.

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

For editorial comment see page 957


© 2009 American College of Chest Physicians


Chest. 2009;136(4):1006-1013. doi:10.1378/chest.08-1938
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Published online

Background:  Accumulated secretions after intubation can affect the resistance of an endotracheal tube (ETT). Our objective was to measure extubated patient tubes and size-matched controls to evaluate differences in resistance.

Methods:  New ETTs, with internal diameters of 7.0 through 8.5 mm, were tested as controls to establish the resistance of each size group as measured by pressure drop. Measurements were obtained using a mass flowmeter and pressure transducer. Pressure drop was measured at three flow rates. Seventy-one patient ETTs were evaluated after extubation by an identical method and compared with controls.

Results:  In each control group, pressure drop was tightly clustered with low variation and no overlap between sizes. A total of 73 to 79% of the patient ETTs had a pressure drop of > 3 SDs of size-matched controls at all flow rates. Pressure drop in 48 to 56% (across three flow rates) of extubated tubes was equivalent to the next smaller size of controls. At 60 and 90 L/min, 10% and 15% of patient tubes, respectively, had the pressure drop of a control tube three sizes smaller. The pressure drop was unpredictable relative to the duration of intubation.

Conclusions:  Organized secretions can significantly increase resistance as measured by the pressure drop of ETTs. The degree of change was highly variable, occurs in all sizes, and was unrelated to the duration of intubation. The performance of an ETT may be comparable to new tubes one to four sizes smaller. This may impact the tolerance of ventilator weaning.

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    Print ISSN: 0012-3692
    Online ISSN: 1931-3543