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Marin H Kollef - One of the best experts on this subject based on the ideXlab platform.
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frequent versus infrequent monitoring of Endotracheal Tube cuff pressures
Respiratory Care, 2018Co-Authors: Adam N Letvin, Pamala Kremer, Patty C Silver, Nizama Samih, Peggy Reedwatts, Marin H KollefAbstract:BACKGROUND: Currently there is no accepted standard of practice for the optimal frequency of Endotracheal Tube cuff pressure monitoring in mechanically ventilated patients. Therefore, we conducted a study to compare infrequent Endotracheal Tube cuff pressure monitoring (immediately after intubation and when clinically indicated for an observed air leak or due to Tube migration) with frequent Endotracheal Tube cuff pressure monitoring (immediately after intubation, every 8 h, and when clinically indicated). METHODS: We performed a prospective clinical trial with subjects assigned to study groups based on room assignment. The primary outcome was the occurrence of a ventilator-associated event (VAE) and was adjudicated by individuals blinded to the conduct of this study. RESULTS: We enrolled 305 subjects, with 166 (54.4%) assigned to frequent monitoring and 139 (45.6%) assigned to infrequent monitoring. The total number of Endotracheal Tube cuff pressure monitoring events for both groups was 1,531 versus 336, respectively. The occurrence of VAEs was infrequent and similar for both groups (3.6% vs 5.8%, P = .37). Witnessed aspiration events (0.6% vs 0%, P = .36), ventilator-associated pneumonia (0% vs 0.7%, P = .27), 30-d mortality (31.3% vs 30.2%, P = .83), and hospital length of stay (10 d [6 d, 21 d] vs 11 d [6 d, 21 d], P = .34) were also similar for both study groups. The 30-d hospital readmission rate was statistically lower for the group that received infrequent monitoring (15.1% vs 6.5%, P = .02). CONCLUSIONS: More frequent cuff pressure monitoring was not associated with any identifiable clinical outcome benefit.
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Endotracheal Tube intraluminal volume loss among mechanically ventilated patients
Critical Care Medicine, 2004Co-Authors: Chirag Shah, Marin H KollefAbstract:OBJECTIVE To measure Endotracheal Tube intraluminal volume loss among mechanically ventilated patients. DESIGN Prospective observational study. SETTING Medical intensive care unit (19 beds) of an urban university-affiliated teaching hospital. PATIENTS A total of 101 patients with acute respiratory failure requiring >24 hrs of mechanical ventilation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Acoustic reflectometry was employed to measure the intraluminal volume of 13-cm Endotracheal Tube segments. The Endotracheal Tube segment volumes were statistically smaller among Endotracheal Tubes used in patients compared with unused Endotracheal Tubes (5.4 +/- 0.7 vs. 6.0 +/- 0.6 mL, p <.001). The average percentage difference in Endotracheal Tube segment volumes, between the unused Endotracheal Tubes and the Endotracheal Tubes used in patients, was 9.8% (range, 0-45.5%). The percentage difference in the Endotracheal Tube segment volumes increased significantly with increasing duration of tracheal intubation (r2 =.766, p <.001). The minimum diameter of the Endotracheal Tube segments was also statistically smaller among Endotracheal Tubes used in patients compared with the unused Endotracheal Tubes (7.5 +/- 0.4 vs. 6.7 +/- 1.2 mm, p <.001). CONCLUSIONS Endotracheal Tube intraluminal volume loss is common among patients with acute respiratory failure requiring mechanical ventilation and increases with prolonged tracheal intubation.
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Endotracheal Tube intraluminal volume loss among mechanically ventilated patients.
Critical care medicine, 2004Co-Authors: Chirag Shah, Marin H KollefAbstract:OBJECTIVE To measure Endotracheal Tube intraluminal volume loss among mechanically ventilated patients. DESIGN Prospective observational study. SETTING Medical intensive care unit (19 beds) of an urban university-affiliated teaching hospital. PATIENTS A total of 101 patients with acute respiratory failure requiring >24 hrs of mechanical ventilation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Acoustic reflectometry was employed to measure the intraluminal volume of 13-cm Endotracheal Tube segments. The Endotracheal Tube segment volumes were statistically smaller among Endotracheal Tubes used in patients compared with unused Endotracheal Tubes (5.4 +/- 0.7 vs. 6.0 +/- 0.6 mL, p
Chirag Shah - One of the best experts on this subject based on the ideXlab platform.
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Endotracheal Tube intraluminal volume loss among mechanically ventilated patients
Critical Care Medicine, 2004Co-Authors: Chirag Shah, Marin H KollefAbstract:OBJECTIVE To measure Endotracheal Tube intraluminal volume loss among mechanically ventilated patients. DESIGN Prospective observational study. SETTING Medical intensive care unit (19 beds) of an urban university-affiliated teaching hospital. PATIENTS A total of 101 patients with acute respiratory failure requiring >24 hrs of mechanical ventilation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Acoustic reflectometry was employed to measure the intraluminal volume of 13-cm Endotracheal Tube segments. The Endotracheal Tube segment volumes were statistically smaller among Endotracheal Tubes used in patients compared with unused Endotracheal Tubes (5.4 +/- 0.7 vs. 6.0 +/- 0.6 mL, p <.001). The average percentage difference in Endotracheal Tube segment volumes, between the unused Endotracheal Tubes and the Endotracheal Tubes used in patients, was 9.8% (range, 0-45.5%). The percentage difference in the Endotracheal Tube segment volumes increased significantly with increasing duration of tracheal intubation (r2 =.766, p <.001). The minimum diameter of the Endotracheal Tube segments was also statistically smaller among Endotracheal Tubes used in patients compared with the unused Endotracheal Tubes (7.5 +/- 0.4 vs. 6.7 +/- 1.2 mm, p <.001). CONCLUSIONS Endotracheal Tube intraluminal volume loss is common among patients with acute respiratory failure requiring mechanical ventilation and increases with prolonged tracheal intubation.
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Endotracheal Tube intraluminal volume loss among mechanically ventilated patients.
Critical care medicine, 2004Co-Authors: Chirag Shah, Marin H KollefAbstract:OBJECTIVE To measure Endotracheal Tube intraluminal volume loss among mechanically ventilated patients. DESIGN Prospective observational study. SETTING Medical intensive care unit (19 beds) of an urban university-affiliated teaching hospital. PATIENTS A total of 101 patients with acute respiratory failure requiring >24 hrs of mechanical ventilation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Acoustic reflectometry was employed to measure the intraluminal volume of 13-cm Endotracheal Tube segments. The Endotracheal Tube segment volumes were statistically smaller among Endotracheal Tubes used in patients compared with unused Endotracheal Tubes (5.4 +/- 0.7 vs. 6.0 +/- 0.6 mL, p
Audrey De Jong - One of the best experts on this subject based on the ideXlab platform.
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Effect of Endotracheal Tube plus stylet versus Endotracheal Tube alone on successful first-attempt tracheal intubation among critically ill patients: the multicentre randomised STYLETO study protocol.
BMJ Open, 2020Co-Authors: Samir Jaber, Amélie Rolle, Boris Jung, Gerald Chanques, Helena Bertet, David Galeazzi, Claire Chauveton, Nicolas Molinari, Audrey De JongAbstract:Tracheal intubation is one of the most daily practiced procedures performed in intensive care unit (ICU). It is associated with severe life-threatening complications, which can lead to intubation-related cardiac arrest. Using a preshaped Endotracheal Tube plus stylet may have potential advantages over Endotracheal Tube without stylet. The stylet is a rigid but malleable introducer which fits inside the Endotracheal Tube and allows for manipulation of the Tube shape; to facilitate passage of the Tube through the laryngeal inlet. However, some complications from stylets have been reported including mucosal bleeding, perforation of the trachea or oesophagus and sore throat. The use of a stylet for first-attempt intubation has never been assessed in ICU and benefit remains to be established.
Ching Tzao - One of the best experts on this subject based on the ideXlab platform.
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video assisted thoracoscopic surgery using single lumen Endotracheal Tube anaesthesia in primary spontaneous pneumothorax
Respirology, 2010Co-Authors: Yeung Leung Cheng, Tsaiwang Huang, Ching Tang Wu, Jenchih Chen, Hung Chang, Ching TzaoAbstract:BACKGROUND AND OBJECTIVE: Primary spontaneous pneumothorax (PSP) is a common condition that typically affects young adults. With recent advances in techniques, VATS is now a safe and accepted procedure for treating PSP. Lung isolation techniques have been commonly used to facilitate surgical procedures in the past. The purpose of this study was to evaluate the feasibility of using a single-lumen Endotracheal Tube for thoracoscopic surgery in patients with PSP. METHODS: A series of 121 consecutive patients with PSP, who underwent VATS using a double-lumen or single-lumen Endotracheal Tube between January 2000 and December 2002, were assessed retrospectively. The clinical features, operation times, complications, hospital stays and recurrences of PSP in these patients were recorded and analysed. RESULTS: There were no significant differences in gender, BMI, smoking habits, blebs/bullae on CT, duration of surgery or recurrence of PSP between the two groups. Patients in the single-lumen Endotracheal Tube group had a shorter duration of anaesthesia (15.4 +/- 2.6 vs 25.6 +/- 3.2 min, P < 0.001), lower early complication rates, lower costs and shorter hospital stays (3.6 +/- 3.0 vs 4.5 +/- 2.8 days, P = 0.02) compared with those in the double-lumen Endotracheal Tube group. The follow-up period was 40-68 months (mean 54 months). There were two recurrences in each group (3.1% vs 3.4%). CONCLUSIONS: VATS for the treatment of PSP was easily performed using a single-lumen Endotracheal Tube, and resulted in lower intubation-related costs, fewer complications and equivalent outcomes, compared with procedures performed using double-lumen Endotracheal Tube anaesthesia.
Maria L Mora - One of the best experts on this subject based on the ideXlab platform.
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continuous Endotracheal Tube cuff pressure control system protects against ventilator associated pneumonia
Critical Care, 2014Co-Authors: Leonardo Lorente, Maria Lecuona, Alejandro Jimenez, L Lorenzo, Isabel Roca, Judith Cabrera, Celina Llanos, Maria L MoraAbstract:Introduction: The use of a system for continuous control of Endotracheal Tube cuff pressure reduced the incidence of ventilator-associated pneumonia (VAP) in one randomized controlled trial (RCT) with 112 patients but not in another RCT with 142 patients. In several guidelines on the prevention of VAP, the use of a system for continuous or intermittent control of Endotracheal cuff pressure is not reviewed. The objective of this study was to compare the incidence of VAP in a large sample of patients (n=284) treated with either continuous or intermittent control of Endotracheal Tube cuff pressure. Methods: We performed a prospective observational study of patients undergoing mechanical ventilation during more than 48 hours in an intensive care unit (ICU) using either continuous or intermittent Endotracheal Tube cuff pressure control. Multivariate logistic regression analysis (MLRA) and Cox proportional hazard regression analysis were used to predict VAP. The magnitude of the effect was expressed as odds ratio (OR) or hazard ratio (HR), respectively, and 95% confidence interval (CI). Results: We found a lower incidence of VAP with the continuous (n = 150) than with the intermittent (n = 134) pressure control system (22.0% versus 11.2%; p = 0.02). MLRA showed that the continuous pressure control system (OR = 0.45; 95% CI = 0.22-0.89; p = 0.02) and the use of an Endotracheal Tube incorporating a lumen for subglottic secretion drainage (SSD) (OR = 0.39; 95% CI = 0.19-0.84; p = 0.02) were protective factors against VAP. Cox regression analysis showed that the continuous pressure control system (HR = 0.45; 95% CI = 0.24-0.84; p = 0.01) and the use of an Endotracheal Tube incorporating a lumen for SSD (HR = 0.29; 95% CI = 0.15-0.56; p < 0.001) were protective factors against VAP. However, the interaction between type of Endotracheal cuff pressure control system (continuous or intermittent) and Endotracheal Tube (with or without SSD) was not statistically significant in MLRA (OR = 0.41; 95% CI = 0.07-2.37; p = 0.32) or in Cox analysis (HR = 0.35; 95% CI = 0.06-1.84; p = 0.21). Conclusions: The use of a continuous Endotracheal cuff pressure control system and/or an Endotracheal Tube with a lumen for SSD could help to prevent VAP in patients requiring more than 48 hours of mechanical ventilation.
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continuous Endotracheal Tube cuff pressure control system protects against ventilator associated pneumonia
Critical Care, 2014Co-Authors: Leonardo Lorente, Maria Lecuona, Alejandro Jimenez, L Lorenzo, Isabel Roca, Judith Cabrera, Celina Llanos, Maria L MoraAbstract:The use of a system for continuous control of Endotracheal Tube cuff pressure reduced the incidence of ventilator-associated pneumonia (VAP) in one randomized controlled trial (RCT) with 112 patients but not in another RCT with 142 patients. In several guidelines on the prevention of VAP, the use of a system for continuous or intermittent control of Endotracheal cuff pressure is not reviewed. The objective of this study was to compare the incidence of VAP in a large sample of patients (n = 284) treated with either continuous or intermittent control of Endotracheal Tube cuff pressure. We performed a prospective observational study of patients undergoing mechanical ventilation during more than 48 hours in an intensive care unit (ICU) using either continuous or intermittent Endotracheal Tube cuff pressure control. Multivariate logistic regression analysis (MLRA) and Cox proportional hazard regression analysis were used to predict VAP. The magnitude of the effect was expressed as odds ratio (OR) or hazard ratio (HR), respectively, and 95% confidence interval (CI). We found a lower incidence of VAP with the continuous (n = 150) than with the intermittent (n = 134) pressure control system (22.0% versus 11.2%; p = 0.02). MLRA showed that the continuous pressure control system (OR = 0.45; 95% CI = 0.22-0.89; p = 0.02) and the use of an Endotracheal Tube incorporating a lumen for subglottic secretion drainage (SSD) (OR = 0.39; 95% CI = 0.19-0.84; p = 0.02) were protective factors against VAP. Cox regression analysis showed that the continuous pressure control system (HR = 0.45; 95% CI = 0.24-0.84; p = 0.01) and the use of an Endotracheal Tube incorporating a lumen for SSD (HR = 0.29; 95% CI = 0.15-0.56; p < 0.001) were protective factors against VAP. However, the interaction between type of Endotracheal cuff pressure control system (continuous or intermittent) and Endotracheal Tube (with or without SSD) was not statistically significant in MLRA (OR = 0.41; 95% CI = 0.07-2.37; p = 0.32) or in Cox analysis (HR = 0.35; 95% CI = 0.06-1.84; p = 0.21). The use of a continuous Endotracheal cuff pressure control system and/or an Endotracheal Tube with a lumen for SSD could help to prevent VAP in patients requiring more than 48 hours of mechanical ventilation.
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influence of an Endotracheal Tube with polyurethane cuff and subglottic secretion drainage on pneumonia
American Journal of Respiratory and Critical Care Medicine, 2007Co-Authors: Leonardo Lorente, Maria Lecuona, Alejandro Jimenez, Maria L Mora, Antonio SierraAbstract:Rationale: Subglottic secretion drainage (SSD) appears to be effective in preventing ventilator-associated pneumonia (VAP), primarily by reducing early-onset pneumonia; but it may not prevent late-onset pneumonia. We tested the hypothesis using an Endotracheal Tube incorporating an ultrathin polyurethane cuff (which reduces channel formation and fluid leakage from the subglottic area), in addition to an SSD lumen, which would reduce the incidence of late-onset VAP.Objectives: To compare the incidence of VAP, using an Endotracheal Tube with polyurethane cuff and subglottic secretion drainage (ETT-PUC-SSD) versus a conventional Endotracheal Tube (ETT-C) with polyvinyl cuff, without subglottic secretion drainage.Methods: Clinical randomized trial in a 24-bed medical–surgical intensive care unit. Patients expected to require mechanical ventilation for more than 24 hours were randomly assigned to one of two groups: one was ventilated with ETT-PUC-SSD and the other with ETT-C.Measurements and Main Results: Trac...