Abstract
The COVID-19 outbreak has increased the incidence of tracheal lesions in patients who underwent invasive mechanical ventilation. We measured the pressure exerted by the cuff on the walls of a test bench mimicking the laryngotracheal tract. The test bench was designed to acquire the pressure exerted by endotracheal tube cuffs inflated inside an artificial model of a human trachea. The experimental protocol consisted of measuring pressure values before and after applying a maneuver on two types of endotracheal tubes placed in two mock-ups resembling two different sized tracheal tracts. Increasing pressure values were used to inflate the cuff and the pressures were recorded in two different body positions. The recorded pressure increased proportionally to the input pressure. Moreover, the pressure values measured when using the non-armored (NA) tube were usually higher than those recorded when using the armored (A) tube. A periodic check of the cuff pressure upon changing the body position and/or when performing maneuvers on the tube appears to be necessary to prevent a pressure increase on the tracheal wall. In addition, in our model, the cuff of the A tube gave a more stable output pressure on the tracheal wall than that of the NA tube.
Highlights
The coronavirus disease 2019 (COVID-19) outbreak has raised many critical issues in the management of patients affected by acute respiratory distress syndrome (ARDS) in an intensive care unit (ICU) setting [1,2]
We investigated the effects of pressure exerted by endotracheal tubes in a mockup resembling the laryngotracheal tract
The underlying hypothesis of our study is the variation in the pressure exerted by the cuff on the tracheal wall depending on the type of tube (NA/A), the maneuvers performed on the tube (T/B), and on the patient’s body position (i.e., S/P), against the same initial insufflation pressure
Summary
The coronavirus disease 2019 (COVID-19) outbreak has raised many critical issues in the management of patients affected by acute respiratory distress syndrome (ARDS) in an intensive care unit (ICU) setting [1,2]. The high incidence of full-thickness tracheal lesions (FTTLs) and tracheoesophageal fistulas (TEFs), and their potential lifethreatening complications, such as pneumomediastinum, pneumothorax, and subcutaneous emphysema, have been reported in patients who underwent invasive mechanical ventilation (MV) [3,4]. This procedure consists of ventilating the respiratory apparatus via an endotracheal polymeric tube with an inflatable cuff that seals the tracheal duct. Many etiopathogenetic hypotheses have been proposed to explain the unprecedented increase in complications observed in ARDS patients treated with MV [3,8]; to date, a clear explanation has not been found
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