• G Conti, M Rocco, R A De Blasi, A Lappa, M Antonelli, M Bufi, and A Gasparetto.
• Institute of Anesthesia and Intensive Care, University of Rome La Sapienza, Italy.
• Intensive Care Med. 1994 Nov 1; 20 (8): 573-6.

ObjectiveTo evaluate the efficiency of a new device developed to remove obstructions from endotracheal tubes (ETT) in mechanically ventilated patients.DesignOpen study in mechanically ventilated sedated and paralyzed ICU patients.SettingGeneral ICU and Laboratory of Respiratory Mechanics of the University of Rome "La Sapienza".Patients8 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.InterventionsObstructions to ETT were removed with an experimental "obstruction remover" (OR) MEASUREMENTS: "In vivo" ETT airflow resistance (0.25; 0.5; 0.75; 11/s) was evaluated before and after use of the OR; the work of breathing necessary to overcome ETT resistance (WOBett) was also evaluated before and after OR use.ResultsThe 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 0.25 l/s, p < 0.05; from 9 +/- 2.4 to 3.8 +/- 0.8 cmH2O/l/s at 0.5 l/s; from 12.2 +/- 3.5 to 5.7 +/- 1.2 cmH2O/l/s at 0.75 l/s; from 16.9 +/- 6 to 9.3 +/- 3.8 cmH2O/l/s at 1 l/s, p < 0.01 respectively). Also the WOBett was significantly reduced after use of the OR (from 0.66 +/- 0.19 to 0.34 +/- 0.08 J/l; p < 0.05).Conclusionthis 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.

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