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 remove obstructions from endotracheal tubes (ETT) in mechanically ventilated patients.Design Open study in mechanically ventilated sedated and paralyzed ICU patients.Setting General ICU and Laboratory of Respiratory Mechanics of the University of Rome La Sapienza.Patients 8 consecutive unselected mechanically ventilated, critically ill patients in which a partial obstruction of ETT was suspected on the basis of an increase of the peak inspiratory pressure (>20%) plus the difficult introduction of a standard suction catheter.Interventions Obstructions to ETT were removed with an experimental obstruction remover (OR)Measurements In vivo ETT airflow resistance (0.25; 0.5; 0.75; 1l/s) was evaluated before and after use of the OR; the work of breathing necessary to overcome ETT resistance (WOB_ett) was also evaluated before and after OR use.Results The use of OR significantly reduced in all patients the ETT in vivo resistance (From 5.5±2.3 to 2.9±0.5 cmH₂O/l/s at 0.25l/s,p<0.05; from 9±2.4 to 3.8±0.8 cmH₂O/l/s at 0.51l/s; from 12.2±3.5 to 5.7±1.2 cmH₂O/l/s at 0.75l/s; from 16.9±6 to 9.3±3.8 cmH₂O/l/s at 1l/s,p<0.01 respectively). Also the WOB_ett was significantly reduced after use of the OR (from 0.66±0.19 to 0.34±0.08 J/l;p<0.05)Conclusion This experimental device can be safely and successfully used to remove obstructions from the ETT lumen, without suspending mechanical ventilation, reducing the need for rapid ETT substitution in emergency and life-threatening situations.