Sound level analysis in endotracheal tube obstruction in spontaneous breathing and mechanical ventilation-an animal model study.

Abstract

Endotracheal tube (ETT) obstruction, either complete or partial, is a serious life threatening complication in intubated patients. Therefore, implementing a practical method to diagnose this condition is vital. Alteration in respiratory sound signals caused by ETT occlusion can be used for early detection of obstruction. This study is aimed to assess changes in respiratory sound signals after creation of different types of tubal obstruction in an animal model experiment. Artificial internal obstructions were created in three different sizes and three different locations by stitching pieces of smaller tubes in ETTs with internal diameter of 8mm. A microphone was used to record respiratory sounds during both spontaneous breathing and mechanical ventilation in seven anesthetized dogs. The sound intensity levels produced by different grades and degrees of obstructions were measured and compared with those in non-obstructed tubes. During spontaneous breathing, significant decrease in sound intensity level was detected even with the lowest grades of obstruction (p = 0.003, 0.001, and 0.002, proximal, middle and distal obstructions, respectively). However, in mechanical ventilation, significant decrease in sound intensity was observed only in distal tubal obstruction (p = 0.037). The difference among levels of sound intensity produced by different obstruction locations of occlusion was not statistically significant (p ≥ 0.090). Data analysis revealed that sound intensity level decreased significantly when the degree of obstruction increased. In addition, this change in sound level was not related to the location of obstruction. The decrease in sound intensity changes can be used to detect ETT obstruction. However, further studies are needed for clinical application.