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Endotracheal tube size to leakage ventilation and tracheal dilatation

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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.

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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

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Acknowledgements

The authors thank Nigel Daly for the English revision.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, St. Joseph’s Hospital, #74 Sinsheng Rd, Huwei, 632, Yunlin County, Taiwan

    Jung-Rern Jiang

  2. Department of Health Protection, Public Health Bureau, No. 34 Fuwen Rd, Douliu, 64054, Yunlin County, Taiwan

    Shiao-Yu Yen

  3. Department of Respiratory Therapist, St. Joseph’s Hospital, #74 Sinsheng Rd, Huwei, 632, Yunlin County, Taiwan

    Pei-Fu Chiang & Hsiao-Chien Liu

Authors
  1. Jung-Rern Jiang
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  2. Shiao-Yu Yen
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  3. Pei-Fu Chiang
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  4. Hsiao-Chien Liu
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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.

Corresponding author

Correspondence to Jung-Rern Jiang.

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Conflict of interest

The authors have no conflicts of interest.

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Jiang, JR., Yen, SY., Chiang, PF. et al. Endotracheal tube size to leakage ventilation and tracheal dilatation. J Anesth 32, 351–359 (2018). https://doi.org/10.1007/s00540-018-2482-z

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  • DOI: https://doi.org/10.1007/s00540-018-2482-z

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