A NEW DEVICE TO REMOVE OBSTRUCTION FROM ENDOTRACHEAL-TUBES DURING MECHANICAL VENTILATION IN CRITICALLY ILL PATIENTS

Objective: To evaluate the efficiency of a new device developed to rem ove obstructions from endotracheal tubes (ETT) in mechanically ventila ted patients. Design: Open study in mechanically ventilated sedated an d paralyzed ICU patients. Setting: General ICU and Laboratory of Respi ratory Mechanics of the University of Rome ''La Sapienza''. Patients: 8 consecutive unselected mechanically ventilated, critically ill patie nts in which a partial obstruction of ETT was suspected on the basis o f an increase of the peak inspiratory pressure (>20%) plus the difficu lt introduction of a standard suction catheter. Interventions: Obstruc tions to ETT were removed with an experimental ''obstruction remover'' (OR) Measurements: ''In vive'' ETT airflow resistance (0.25; 0.5; 0.7 5; 1 l/s) was evaluated before and after use of the OR; the work of br eathing necessary to overcome ETT resistance (WOBett) was also evaluat ed before and after OR use. Results: The use of OR significantly reduc ed in all patients the ETT ''in vive'' resistance (From 5.5+/-2.3 to 2 .9+/-0.5 cmH(2)O/l/s at 0.25 l/s, p<0.05; from 9+/-2.4 to 3.8+/-0.8 cm H(2)O/l/s at 0.51/s; from 12.2,3.5 to 5.7+/-1.2 cmH(2)O/l/s at 0.75 l/ s; from 16.9+/-6 to 9.3+/-3.8 cmH(2)O/l/s at 1 l/s, p<0.01 respectivel y). Also the WOBett was significantly reduced after use of the OR (fro m 0.66+/-0.19 to 0.34+/-0.08 J/1; p<0.05) Conclusion: this experimenta l device can be safely and successfully used to remove obstructions fr om the ETT lumen, without suspending mechanical ventilation, reducing the need for rapid ETT substitution in emergency and life-threatening situations.