Does endo-tracheal tube clamping prevent air leaks and maintain positive end-expiratory pressure during the switching of a ventilator in a patient in an intensive care unit? A bench study

Abstract

ObjectivesWhen patients with acute respiratory distress syndrome are moved out of an intensive care unit, the ventilator often requires changing. This procedure suppresses positive end expiratory pressure and promotes lung derecruitment. Clamping the endotracheal tube may prevent this from occurring. Whether or not such clamping maintains positive end-expiratory pressure has never been investigated. We designed a bench study to explore this further. How the study was doneWe used the Elysee 350 ventilator in 'volume controlled' mode with a positive end-expiratory pressure of 15 cmH2O, connected to an endotracheal tube with an 8 mm internal diameter inserted into a lung model with 40 ml/cmH2O compliance and 10 cmH2O/L/s resistance. We measured airway pressure and flow between the distal end of the endotracheal tube and the lung model. We tested a plastic, a metal, and an Extra Corporeal Membrane Oxygenation clamp, each with an oral/nasal, a nasal, and a reinforced endotracheal tube. We performed an end-expiratory hold then clamped the endotracheal tube and disconnected the ventilator. We measured the change in airway pressure and volume for 30 s following the disconnection of the ventilator.

Respiratory care for the critical patients with 2019 novel coronavirus

“…Their results showed that the extracorporeal membrane oxygenation (ECMO) clamp had the best performance in preventing leak (volume loss) after circuit disconnection. The leakage results were ECMO clamp (15ml/5s; 20ml/30s), metal clamp (113ml/5s; 423ml/30s) and plastic clam (693ml/5s; 692ml/30s) respectively [ 104 ].…”

Practical strategies to reduce nosocomial transmission to healthcare professionals providing respiratory care to patients with COVID-19

“…When transporting a mechanically ventilated COVID-19 patient, it is suggested that a filter HME be placed between the artificial airway and the transport ventilator circuit [ 53 ]. Before pausing the ICU ventilator, consider clamping the endotracheal tube (ETT) to prevent derecruitment and minimize the spread of bio-aerosols when transitioning patients from the ICU ventilator to the transport ventilator [ 5 , 87 , 88 ]. When returning to the ICU, clamp the ETT and leave the filter connected to it to prevent accidental exposure.…”

Feasibility of sedation with sevoflurane inhalation via AnaConDa for Covid-19 patients under venovenous extracorporeal membrane oxygenation

“…In order to minimize the risk, closed circuit endotracheal suctioning was used. Endo-tracheal tube clamping was realized with ECMO clamps (18) during the installation of the device, which requires disconnection and reconnection from the ventilatory circuit. According to Sedana Medical, the virus filtration capacity of AnaConDa is superior to 99.9% for 27 nm particles, which corresponds to less than a quarter of the SARS-CoV-2 virus size (120-160mm) (19).…”