Tracheal Tube Obstruction in Mechanically Ventilated Patients Assessed by High-resolution Computed Tomography

Abstract

TT luminal narrowing is a common finding and correlates with increased airflow resistance. The authors propose high-resolution CT as a novel technique to visualize and quantify secretions collected within the TT lumen.

Endotracheal Tubes Cleaned With a Novel Mechanism for Secretion Removal: A Randomized Controlled Clinical Study

“…Moreover, a variable degree of mucus partially occluding the ETT could also be visualized on standard chest CT scans. 3 Compared with acoustic reflectometry, our novel assay based on HRCT offers several advantages, including: (1) the direct visualization and quantitation of mucus volume, and (2) a precise definition of the mucus accumulation pattern across the whole ETT length. Currently, blind suctioning through a small flexible catheter is the most common method to remove secretions from within the ETT.…”

“…3 Routine identification and quantitation of bacterial and fungal isolates were obtained from each collected ETT. Resistance to major antibiotics was also tested.…”

“…3 Raw imaging data of mucus and air volumes (mL) were acquired and subsequently converted to volume percentages (mucus/[mucusϩair], % mL). We, therefore, report as "overall occlusion" the average ratio of mucus versus total ETT inner volume (mucusϩair) throughout the whole 22 cm tube portion.…”

“…The degree of ETT occlusion positively correlated with in vitro measurements of air flow resistance. 3 This process of mucus buildup and luminal narrowing leads to an increased ventilatory effort and might delay liberation from the ventilator. 4,5 In addition, potential lung pathogens often colonize the ETT lumen.…”

Tracheal tube biofilm removal through a novel closed-suctioning system: an experimental study

“…In clinical practice, such a situation would be uncommon, but potentially life-threatening. 36 Partial obstruction of the TT, however is frequent and leads to increased airflow resistance, 37 breathing difficulties and delayed weaning from MV. 11 38 This evidence, in addition to future laboratory/clinical trials demonstrating reduced incidence of VAP, would support the routine use of these devices.…”