How to avoid an epidemic of endotracheal tube occlusion

Lellouche, François; Lavoie-Bérard, Carole-Anne; Rousseau, Elsa; Bouchard, Pierre-Alexandre; Lefebvre, Jean-Claude; Branson, Richard D.; Brochard, Laurent

doi:10.1016/s2213-2600(21)00404-5

Cited by 9 publications

(5 citation statements)

References 17 publications

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“…The minimum absolute humidity to be delivered in mechanically ventilated patients is usually define as above 28-30 mgH 2 O/L, depending of the reference method used 7,15,17 . Below these levels, there are increasing risk of occlusions 14,[18][19][20] , a late marker of under-humidification or of endotracheal tube sub-occlusions [21][22][23] or muco-ciliary dysfunction 24 .…”

Section: Discussionmentioning

confidence: 99%

“…The humidity delivered at the Y-piece is closely related to the heater plate temperature as previously shown 6 , consequently every situation leading to high temperature in the humidification chamber (high ambient or ventilator temperature, sun shining directly on the humidifier). During COVID-19 pandemic, high rates of endotracheal tube occlusions have been described with poor performing HMEs and even with HH when not used in optimal conditions [7][8][9][10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Humidification Performances of New Generation of Heated Wire Humidifiers

Lellouche,

Rousseau,

Bouchard

2023

Respir Care

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BackgroundAt high ambient temperatures in ICU rooms, the humidification performances of heated wire humidifiers (HH) are significantly reduced, with delivered gas humidity well below 30 mgH 2 O/L leading to an increased risk of endo-tracheal occlusions, sub-occlusions or mucociliary dysfunction.The objective of the study was to evaluate the humidity delivered at the Y-piece with new generation HH with advanced algorithm (FP950 and VHB20) while varying ambient temperatures. MethodsWe measured on bench the hygrometry of inspiratory gases delivered by new generation of HH (i) FP950 (Fisher&Paykel Healthcare) (ii) VHB20 (Vincent Medical) and previous generation of HH (iii) MR850 with usual settings (37 at the chamber/40 at the Y piece) (iv) MR 850 with no temperature gradient (40/40), and (v) MR850 with automatic compensation algorithm activated. Hygrometry was measured with the psychrometric method after one hour of stability while varying the room temperature from 20 to 30°C. ResultsTwo hundred and ninety-four hygrometric bench measurements were performed at steady state for the different tested conditions. With the new HH (FP950 and VHB20), gas humidity delivered remained above 30 mgH 2 O/L in all tested conditions, even at high ambient temperatures (> 25°C).With previous generation of HH (MR850), at high ambient temperature, humidity delivered was adequate in only 26% (11/42) of the measurements when usual settings were used (37/40) and 30% (11/37) with automatic compensation. When no temperature gradient was set (40/40), humidity delivered was above 30 mgH 2 O/L in 91% (30/33) of the measurements at high ambient temperature.With ambient temperature below 25°C, almost all devices and settings provided adequate humidity. ConclusionThe new FP950 and VHB20 heated wire heated humidifiers using advanced algorithms have demonstrated stable performance while varying the ambient temperature by 20-30°C, better than the previous generation of heated humidifiers when ambient temperatures were high.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of the Humidification Performances of New Generation of Heated Wire Humidifiers

Lellouche,

Rousseau,

Bouchard

2023

Respir Care

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“…This emphasized the importance of airway humidification for patients with artificial airways and provided ideas for the management of artificial airways. Lellouche et al (2021) emphasized a humidity of 28 mg H 2 O/L was considered to be safe when choose the heated humidifiers to prevent the tube occlusion. In addition, frequent suctioning reduces patient tolerance.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Risk Assessment Tool for Unplanned Endotracheal Extubation: An Observational Study

Zhang

Liu

2022

Clin Nurs Res

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The purpose of this study was to validate and determine the sensitivity and specificity of the risk assessment tool for unplanned endotracheal extubation. Unplanned endotracheal extubation is a common adverse event. The rate of unplanned endotracheal extubation is an indicator to measure patient safety and medical quality. This study was conducted in five intensive care units in a tertiary-A hospital. A total of 227 samples encounters were obtained from 147 unique patients. The content validity was 0.91, and the item content validity ranged from 0.80 to 1.00. Cronbach’s α was .58, the interrater reliability was .93. The area under the curve was 0.89 (95% CI [0.84, 0.94], p < 0.01), the sensitivity was 87.80%, and the specificity was 74.20%. This tool presented good reliability and validity and can be used to assess the risk of unplanned endotracheal extubation in patients with artificial airways.

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“…Indeed, this process occurs to varying degrees in all intubated patients, beginning within hours of endotracheal intubation [ 4 ]. As one example, mechanical ventilation with tracheal intubation has become essential in the management of severe COVID-19 infections [ 5 ], and in a recent study, a high ETT occlusion rate (i.e., ≤ 72%) has been described in COVID-19 patients [ 6 ]. In this context, a microscopic examination of a patient’s ETT content showed a trilaminar appearance, with a superficial layer of mucin, inflammatory cell degeneration, and intercellular stroma [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

A novel antibacterial and antifouling nanocomposite coated endotracheal tube to prevent ventilator-associated pneumonia

Wang

Cai

et al. 2022

J Nanobiotechnol

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Background The endotracheal tube (ETT) is an essential medical device to secure the airway patency in patients undergoing mechanical ventilation or general anesthesia. However, long-term intubation eventually leads to complete occlusion, ETTs potentiate biofilm-related infections, such as ventilator-associated pneumonia. ETTs are mainly composed of medical polyvinyl chloride (PVC), which adheres to microorganisms to form biofilms. Thus, a simple and efficient method was developed to fabricate CS-AgNPs@PAAm-Gelatin nanocomposite coating to achieve dual antibacterial and antifouling effects. Results The PAAm-Gelatin (PAAm = polyacrylamide) molecular chain gel has an interpenetrating network with a good hydrophilicity and formed strong covalent bonds with PVC-ETTs, wherein silver nanoparticles were used as antibacterial agents. The CS-AgNPs@PAAm-Gelatin coating showed great resistance and antibacterial effects against Staphylococcus aureus and Pseudomonas aeruginosa. Its antifouling ability was tested using cell, protein, and platelet adhesion assays. Additionally, both properties were comprehensively evaluated using an artificial broncho-lung model in vitro and a porcine mechanical ventilation model in vivo. These remarkable results were further confirmed that the CS-AgNPs@PAAm-Gelatin coating exhibited an excellent antibacterial capacity, an excellent stain resistance, and a good biocompatibility. Conclusions The CS-AgNPs@PAAm-Gelatin nanocomposite coating effectively prevents the occlusion and biofilm-related infection of PVC-ETTs by enhancing the antibacterial and antifouling properties, and so has great potential for future clinical applications. Graphical Abstract

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How to avoid an epidemic of endotracheal tube occlusion

Cited by 9 publications

References 17 publications

Evaluation of the Humidification Performances of New Generation of Heated Wire Humidifiers

Evaluation of the Humidification Performances of New Generation of Heated Wire Humidifiers

Validation of a Risk Assessment Tool for Unplanned Endotracheal Extubation: An Observational Study

A novel antibacterial and antifouling nanocomposite coated endotracheal tube to prevent ventilator-associated pneumonia

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