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Respiratory Care |

Use of a Unique Endotracheal Tube Clearing Device to Decrease Airway Resistance

Christopher Waters*, MS; Hamed Motlagh, MPH; John Thomas, PhD; Alison Wilson, MD
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West Virginia University, Morgantown, WV


Chest. 2012;142(4_MeetingAbstracts):952A. doi:10.1378/chest.1390448
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Abstract

SESSION TYPE: Respiratory Support Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: In 2009, we unmasked the unpredictable collateral damage of endotracheal tube (ETT) biofilm-accretion occlusion and concomitant increased airway resistance in 100% of MV patients. The aim of the pilot study was to measure the impact of the EndOclear Clearing Device (ECCD), evaluate ETT occlusion, and assess the return of the ETT to a “nominal” airway (slpm) function, independent of occlusion, tube size and LOI. A return to ETT luminal patency would amplify early weaning trials and subsequent shortened Length of Stay (LOI), or Ventilation Hours.

METHODS: 40 extubated ETTs were collected from patients intubated over 24hrs at WVUH, Level 1 Trauma Center. Airway resistance was measured using Puritan Bennett’s PTS-2000 instrument and Breathlab software. A metered flow rate of compressed air was administered at 0-100 LPM over 30sec to an extubated ETT. Values at 30, 60, 90 L/min were emphasized mimicking WVUH ranges for COPD and ARDS. Biofilm-accretion was extracted, distal end first in 8 seconds.

RESULTS: The ECCD removed 0.05-2.75cc of material from 100% occluded extubated ETTs. For ETT sizes received (7.0, 7.5, 8.0 mm), the range of pressure drop at three intervals (30, 60, 90 slpm) was 16.3% to 60.2% (Pre) prior to clearing and correspondingly post clearing (Post), 1.96%-11.14%. At 60slpm, the pressure drop resulted in 24.2% to 60.2% (Pre), while clearing decreased pressure drop by 15.45% to 49.06%. Pressure drop in 56-75% (@ 30, 60, 90 L/min) of extubated tubes was equivalent to the next smaller size of controls prior to endOclear device use. At 60 and 90 L/min, 60% of patient tubes had the pressure drop of a control tube two sizes smaller.

CONCLUSIONS: Following ECCD clearing, extubated ETT resistance was returned to within 11% of nominal for all tubes independent of occlusion, tube size or LOI. Results corroborated the original observations and the significant impact of occlusion on air flow for all tubes.

CLINICAL IMPLICATIONS: Routine use of ECCD would maintain “nominal” airway function for MV patients, potentially reducing LOI while impacting weaning trials.

DISCLOSURE: The following authors have nothing to disclose: Christopher Waters, Hamed Motlagh, John Thomas, Alison Wilson

No Product/Research Disclosure Information

West Virginia University, Morgantown, WV

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