T. Kolobow et al., DESIGN AND DEVELOPMENT OF ULTRATHIN-WALLED, NONKINKING ENDOTRACHEAL-TUBES OF A NEW NO-PRESSURE LARYNGEAL SEAL DESIGN - A PRELIMINARY-REPORT, Anesthesiology, 81(4), 1994, pp. 1061-1067
Background: Endotracheal tubes (ETTs) of conventional design and manuf
acture greatly increase the air-flow resistance of the upper airways.
This increase in upper-airway resistance can lead to a significant inc
rease in the work of breathing and may necessitate the use of assisted
mechanical ventilation. Current ETTs are relatively stiff and contrib
ute greatly to patient discomfort. The inflatable cuffs now mounted on
to the ETTs function well in short-term use but impart significant mor
bidity when used over longer periods. These issues were addressed by t
he designing of a low-resistance ETT. Methods: Using new techniques, w
e developed ultrathin-walled, wire reinforced ETTs of conventional con
figuration and ETTs the oropharyngeal-section diameter of which was a
few millimeters larger than the diameter of the tracheal section. The
wall thickness was a constant 0.20 mm. The wire reinforcement was stai
nless steel flat wire or superelastic nickel-titanium alloy. The super
elastic nickel-titanium alloy reinforcement made those ETTs crush-proo
f; after forceful manual compression, recovery was complete. To obtain
a seal with the upper airways, we first shaped a short section of the
oropharyngeal section of the ETT from round to oval (or egg-shaped) t
o conform better to the larynx. We then attached to this segment numer
ous soft, pliable, 0.025-0.075-mm-thick rings of polyurethane to occlu
de voids for potential air leaks from within the larynx.Results: In vi
tro pressure-flow studies showed a decrease by as much as four- or fiv
efold in air-flow resistance in the adult ETT range, effectively incre
asing the internal diameter by 2.3-3.7 mm, compared with conventional
ETTs of the same outside diameter. In vivo studies for 24 h in sheep s
howed no air leaks at airway pressures to 30 cmH(2)O and minimal leak
at greater pressures. The gross appearance of the trachea was normal.
Conclusions: Although the new tubes appear to offer advantages to thos
e currently used, testing in humans is required to assess the clinical
utility of the tube-cuff design.