Endotracheal tube size to leakage ventilation and tracheal dilatation

  • Jung-Rern Jiang
  • Shiao-Yu Yen
  • Pei-Fu Chiang
  • Hsiao-Chien Liu
Original Article
  • 62 Downloads

Abstract

Purpose

This study analyzed the clinical factors with the aim to determine the relationship between endotracheal tube (ETT) size and leakage ventilation (LV) and tracheal dilatation.

Methods

All patients with ETT intubation and ventilator support for more than 6 months were retrospectively evaluated. The inner tracheal diameter (TD) was measured over image at the starting and 6 months after ventilator initiated. We compared the clinical factors, outcomes and complications between patients with and without LV, as well as with and without a TD enlarging more than 25% after 6 months (TDn). Logistic regression analyses of factors related to the LV and TDn were performed. The cut-off points of the ratio of outer diameter of ETT (OD) to TD were set and evaluated for their accuracy of predicting LV and TDn.

Results

689 patients were enrolled initially and eventually 199 patients were included, of which 52 and 66 patients were identified to have LV and TDn, respectively. Patients with LV had a higher peak inspiratory pressure (PIP), smaller initial ETT OD/TD and higher incidence of pneumonia. Patients with TDn had a higher PIP, larger initial OD/TD and higher incidence of pneumonia. A higher PIP and smaller initial OD/TD were significantly related to LV and a higher PIP and larger initial OD/TD were significantly related to TDn. The incidence of LV and TDn was higher in patients with an initial OD/TD less than 0.51 and more than 0.54, respectively.

Conclusion

The initial ETT OD/TD ratio is a predictor for LV and TDn.

Keywords

Critical care Tracheomalacia Ventilators, mechanical Respiratory insufficiency Intubation 

Abbreviations

ETT

Endotracheal tube

LCs

Lung compliance

LV

Leakage ventilation

MV

Mechanical ventilation

NLV

Leakage-free ventilation

OD

Outer diameter of endotracheal tube

PIP

Peak inspiratory pressure

Raw

Airway resistance

TD

Inner tracheal diameter

TDn

Tracheal dilatation with a TD enlarging more than 25% after 6 months

NTDn

Non-TDn

Notes

Acknowledgements

The authors thank Nigel Daly for the English revision.

Author contributions

JJ-R contributed to literature search, study design, manuscript preparation, and review of manuscript. YS-Y contributed to literature search, study design, analysis of data, and review of manuscript. CP-F contributed to literature search, data collection, study design, and review of manuscript. LH-C contributed to literature search, data collection, study design, and review of manuscript.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest.

Supplementary material

540_2018_2482_MOESM1_ESM.tif (65 kb)
Supplementary material 1 (TIF 64 kb)
540_2018_2482_MOESM2_ESM.docx (12 kb)
Supplementary material 2 (DOCX 11 kb)

References

  1. 1.
    Fernandez-Bussy S, Mahajan B, Folch E, Caviedes I, Guerrero J, Majid A. Tracheostomy tube placement: early and late complications. J Bronchol Interv Pulmonol. 2015;22(4):357–64.CrossRefGoogle Scholar
  2. 2.
    Stone DJ, Bogdonoff DL. Airway considerations in the management of patients requiring long-term endotracheal intubation. Anesth Analg. 1992;74:276–87.CrossRefPubMedGoogle Scholar
  3. 3.
    Rhodes A, Lamb FJ, Grounds RM, Bennett ED. Tracheal dilatation complicating prolonged tracheal intubation. Anaesthesia. 1997;52(1):70–2.CrossRefPubMedGoogle Scholar
  4. 4.
    Gupta N. Endotracheal tube leak: what should we do? J Anaesthesiol Clin Pharmacol. 2015;31(4):459.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Haas CF, Eakin RM, Konkle MA, Blank R. Endotracheal tubes: old and new. Respir Care. 2014;59(6):933–52.CrossRefPubMedGoogle Scholar
  6. 6.
    Prinsley P. Ballooned trachea as a consequence of intubation. J Laryngol Otol. 1992;106:561–2.CrossRefPubMedGoogle Scholar
  7. 7.
    Pacheco-Lopez PC, Berkow LC, Hillel AT, Akst LM. Complications of airway management. Respir Care. 2014;59(6):1006–19.CrossRefPubMedGoogle Scholar
  8. 8.
    Majid A, Fernandez L, Fernandez-Bussy S, Herth F, Ernst A. Tracheobronchomalacia. Arch Bronconeumol. 2010;46:196–202.CrossRefPubMedGoogle Scholar
  9. 9.
    Tempe DK, Goel S. Over-distended tracheostomy tube cuff: a sign of tracheomalacia. Ann Card Anaesth. 2007;10(2):154.CrossRefPubMedGoogle Scholar
  10. 10.
    Branson RD. Endotracheal tubes and imposed work of breathing: what should we do about it, if anything? Crit Care. 2003;7(5):347–8.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Hwang JY, Park SH, Han SH, Park SJ, Park SK, Kim JH. The effect of tracheal tube size on air leak around the cuffs. Korean J Anesthesiol. 2011;61(1):24–9.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Colton House J, Noordzij JP, Murgia B, Langmore S. Laryngeal injury from prolonged intubation: a prospective analysis of contributing factors. Laryngoscope. 2011;121(3):596–600.CrossRefPubMedGoogle Scholar
  13. 13.
    Ilan O, Gross M, Zaltzman Y, Sasson A, Marcus EL. Diagnosis and conservative management of late tracheotomy complications in chronic ventilator-dependent patients. Head Neck. 2015;37(5):716–21.CrossRefPubMedGoogle Scholar
  14. 14.
    Power KJ. Foam cuffed tracheal tubes: clinical and laboratory assessment. Br J Anaesth. 1990;65(3):433–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Epstein SK. Late complications of tracheostomy. Respir Care. 2005;50:542–9.PubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of Internal MedicineSt. Joseph’s HospitalHuweiTaiwan
  2. 2.Department of Health ProtectionPublic Health BureauDouliuTaiwan
  3. 3.Department of Respiratory TherapistSt. Joseph’s HospitalHuweiTaiwan

Personalised recommendations