Abstract
ObjectivesWhen patients with acute respiratory distress syndrome are moved out of an intensive care unit, the ventilator often requires changing. This procedure suppresses positive end expiratory pressure and promotes lung derecruitment. Clamping the endotracheal tube may prevent this from occurring. Whether or not such clamping maintains positive end-expiratory pressure has never been investigated. We designed a bench study to explore this further.How the study was doneWe used the Elysee 350 ventilator in ‘volume controlled’ mode with a positive end-expiratory pressure of 15 cmH2O, connected to an endotracheal tube with an 8 mm internal diameter inserted into a lung model with 40 ml/cmH2O compliance and 10 cmH2O/L/s resistance. We measured airway pressure and flow between the distal end of the endotracheal tube and the lung model. We tested a plastic, a metal, and an Extra Corporeal Membrane Oxygenation clamp, each with an oral/nasal, a nasal, and a reinforced endotracheal tube. We performed an end-expiratory hold then clamped the endotracheal tube and disconnected the ventilator. We measured the change in airway pressure and volume for 30 s following the disconnection of the ventilator.ResultsAirway pressure decreased thirty seconds after disconnection with all combinations of clamp and endotracheal tube. The largest fall in airway pressure (-17.486 cmH2O/s at 5 s and -18.834 cmH2O/s at 30 s) was observed with the plastic clamp combined with the reinforced endotracheal tube. The smallest decrease in airway pressure (0 cmH2O/s at 5 s and -0.163 cmH2O/s at 30 s) was observed using the Extra Corporeal Membrane Oxygenation clamp with the nasal endotracheal tube.ConclusionsOnly the Extra Corporeal Membrane Oxygenation clamp was efficient. Even with an Extra Corporeal Membrane Oxygenation clamp, it is important to limit the duration the ventilator is disconnected to a few seconds (ideally 5 s).
Highlights
Moving patients on invasive mechanical ventilation out of the intensive care unit (ICU) often requires switching them from a standard ICU ventilator to a portable one
Even with an Extra Corporeal Membrane Oxygenation clamp, it is important to limit the duration the ventilator is disconnected to a few seconds
The use of a portable ventilator, with a lower performance than the ICU ventilators in terms of tidal volume delivery and positive end expiratory pressure (PEEP), may result in hypoventilation and/or lung derecruitment [9,10,11]. Another factor is air leaks that may occur after the procedure described above, i.e. the clamping of the endotracheal tube (ETT) followed by disconnection from the ventilator, should the clamping be only partly effective
Summary
Moving patients on invasive mechanical ventilation out of the intensive care unit (ICU) often requires switching them from a standard ICU ventilator to a portable one. The use of a portable ventilator, with a lower performance than the ICU ventilators in terms of tidal volume delivery and positive end expiratory pressure (PEEP), may result in hypoventilation and/or lung derecruitment [9,10,11]. Another factor is air leaks that may occur after the procedure described above, i.e. the clamping of the ETT followed by disconnection from the ventilator, should the clamping be only partly effective. Lu et al compared the derecruited lung volume after PEEP removal, measured with a Pressure-Volume (VP) curve, with that measured with CT clamping of the ETT during image acquisition [15]
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