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Double-lumen endotracheal tube for percutaneous tracheostomy: in vitro and in vivo preliminary data
Critical Care volume 18, Article number: P324 (2014)
A double-lumen endotracheal tube (DLET; bilumen ventilation tube, PCT/IT2012/000154; Deas S.r.l., Italy) (Figure 1) has been developed to improve the safety of patients and procedural comfort during percutaneous tracheostomy (PT). The DLET is divided into an upper channel, for placement of a fiberoptic bronchoscope (FOB), and a lower channel exclusively dedicated to the patient's ventilation. The aim of this study is to achieve an in vitro and an in vivo evaluation of PT performed with the DLET.
The nonlinear constant of the Rohrer equation (K2)) was calculated as resistive properties, during a continuous flow of 10 to 90 l/minute, for a conventional endotracheal tube (ETT) with and without FOB (ETT size 7, 7.5, 8, 7f, 7.5f, 8f), ventilation tube of TLT (F4 and F5) and DLET. The variation of gas exchange (Δ) was measured with arterial blood gas samples obtained before and after the PT. During PT, all patients received sedation, analgesia, neuromuscular blocking and volume-controlled ventilation set with FiO2 100%, TV 500 ml, RR 15 breaths/minute, PEEP 5 cmH2O.
In vitro evaluation showed that the DLET had the lowest K2 (7 = 11.33; 7.5 = 8.74; 8 = 7.57; 7f = 6.13; 7.5f = 10.52; 8f = 12.28; F4 = 130.0; F5 = 11.12; DLET = 5.25 cmH2O/l/minute). During in vivo evaluation, PT was performed with the conventional ETT with FOB and DLET for five patients in each group (age 69 ± 13 vs. 71 ± 16; SAPS II: 56 ± 14 vs. 52 ± 20; GCS 3 vs. 4). Gas exchange before and after the procedure did not differ between the groups, but the Δ values of pH, PaO2 and PaCO2 measured before and after the procedure were, ETT+FOB versus DLET: ΔpH: −0.05 ± 0.05 versus 0.01 ± 0.02, P = 0.04; ΔPaO2: −112.6 ± 112.6 versus 41.6 ± 25.3, P = 0.01; ΔPaCO2: 14.5 ± 10.8 versus 0.6 ± 1.1, P = 0.02; AHCO3: 0.5 ± 2 versus −0.04 ± 0.3, P = 0.6.
The DLET resulted in adequate airway patency and minimal obstruction due to the lower channel exclusively dedicated to patient's ventilation. Gas exchange in PT with the DLET remained stable without any variation in oxygenation and carbon dioxide levels, although the same settings of mechanical ventilation.
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Vargas, M., Servillo, G., Marra, A. et al. Double-lumen endotracheal tube for percutaneous tracheostomy: in vitro and in vivo preliminary data. Crit Care 18, P324 (2014). https://doi.org/10.1186/cc13514
- Neuromuscular Blocking
- Airway Patency
- Fiberoptic Bronchoscope
- Percutaneous Tracheostomy
- Lower Channel