Continuous Calculation of Intratracheal Pressure in Tracheally Intubated Patients

Guttmann, J.; Eberhard, L.; Fabry, Ben; Bertschmann, W; Wolff, G.

doi:10.1097/00000542-199309000-00014

Cited by 215 publications

(179 citation statements)

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“…1,2 An ETT is the narrowest component of the whole pneumatic connection between a patient and a ventilator. 3 The resistive properties of the ETT substantially influence inspiratory and expiratory WOB.…”

Section: Introductionmentioning

confidence: 99%

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Potential Inadequacy of Automatic Tube Compensation to Decrease Inspiratory Work Load After at Least 48 Hours of Endotracheal Tube Use in the Clinical Setting

Oto

Imanaka

Nakataki³

et al. 2012

Respir Care

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BACKGROUND: Endotracheal tubes (ETTs) impose a substantial respiratory work load on mechanically ventilated patients. Automatic tube compensation (ATC) should overcome this flowdependent resistive work load; however, ETT resistance can be increased by tracheal secretions or ETT deformities. Our bench study investigated whether ATC provides effective respiratory work load relief in used ETTs. METHODS: We enrolled 20 critically ill patients requiring mechanical ventilation for longer than 48 hours. After extubation, we collected the used ETTs and measured the pressure-time products (PTPs) by using a bellows-in-a-box lung model that simulated spontaneous breathing, at a respiratory rate of 10 breaths/min, inspiratory time of 1.0 s, and tidal volumes (V T ) of 300 mL, 500 mL, and 700 mL. The ventilator was set at ATC 100% with PEEP of 5 cm H 2 O and F IO 2 of 0.21. The flow and airway pressure at the proximal (P aw ) and distal (P tr ) ends of the ETT were recorded, and the PTP integrated from P tr analyzed. RESULTS: PTP values increased with V T during ATC. Even at 100% ATC the ventilator did not completely compensate for the PTP imposed by the ETT. In used ETTs, peak flow and peak P aw were lower and PTP values were greater than in new ETTs. As V T increased, the percentage difference in the PTP values between the new and used ETTs increased. CONCLUSIONS: ATC does not necessarily compensate for an ETT-imposed respiratory work load. ETT configuration changes and tracheal secretions can increase ETT resistance and decrease the ability of ATC to compensate for the increased respiratory work load.

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Section: Introductionmentioning

confidence: 99%

“…3 The resistive properties of the ETT substantially influence inspiratory and expiratory WOB. [1][2][3] related to an ETT has been shown to vary from 5 to 22 cm H 2 O. 4 Automatic tube compensation (ATC) was developed to overcome the ETT-imposed respiratory work load.…”

Section: Introductionmentioning

confidence: 99%

Potential Inadequacy of Automatic Tube Compensation to Decrease Inspiratory Work Load After at Least 48 Hours of Endotracheal Tube Use in the Clinical Setting

Oto

Imanaka

Nakataki³

et al. 2012

Respir Care

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show abstract

“…the airway opening, the trachea or at the alveoli, pressure measurements are of interest. If the patient is intubated, tracheal pressure (P trach ) is sometimes more desired than P aw since the endotracheal tube contributes significantly to total airflow resistance, and thus affects the R rs calculation (Guttmann et al, 1993). Alveolar pressure (P alv ) is a decisive factor of alveolar recruitment/derecruitment.…”

mentioning

confidence: 99%

Optimizing Perioperative Ventilation Support with Adequate Settings of Positive End-Expiratory Pressure

Zhao¹,

Stahl²,

Müller-Lisse³

et al. 2012

Front Lines of Thoracic Surgery

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“…Because resistance of tracheal tubes (Ret) varies significantly with flow, PAV (whose working principle requires a constant resistance) will poorly compensate for Ret. [5][6][7] One way to accommodate the tracheal tube resistive load is to use modes such as the automated tube compensation, which computes the ventilator pressure required to compensate for the resistance of the tracheal tube for every breath. However, there are limitations with these systems which do not always perform as expected, yielding suboptimal compensation of the endotracheal tube resistance.…”

mentioning

confidence: 99%

“…Parce que la résistance des tubes trachéaux (Ret) varie considérablement selon le débit, la PAV (dont le principe de fonctionnement nécessite une résistance constante) ne compensera par correctement la Ret. [5][6][7] Une façon d'éliminer la charge résistive du tube trachéal est d'utiliser des modes tels que la compensation de tube automatique (automatic tube compensation), qui calcule la pression inspiratoire requise afin de compenser la résistance du tube trachéal à chaque respiration. Toutefois, ces systèmes ont des limites et ne fonctionnent pas toujours tel qu'attendu, fournissant alors une compensation sous-optimale à la résistance du tube endotrachéal.…”

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Enhancing ventilatory strategies for the critically ill — proportional assist ventilation

Lessard

2007

Can J Anesth/J Can Anesth

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Continuous Calculation of Intratracheal Pressure in Tracheally Intubated Patients

Cited by 215 publications

References 0 publications

Potential Inadequacy of Automatic Tube Compensation to Decrease Inspiratory Work Load After at Least 48 Hours of Endotracheal Tube Use in the Clinical Setting

Potential Inadequacy of Automatic Tube Compensation to Decrease Inspiratory Work Load After at Least 48 Hours of Endotracheal Tube Use in the Clinical Setting

Optimizing Perioperative Ventilation Support with Adequate Settings of Positive End-Expiratory Pressure

Enhancing ventilatory strategies for the critically ill — proportional assist ventilation

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