A fibre optics system for the evaluation of airway pressure in mechanically ventilated patients

Abstract

Objective: The present study was intended to evaluate the "in vivo" endotracheal (ET) tube resistance and respiratory mechanics in mechanically ventilated patients with respiratory failure by using fiber optic catheters.

Design: Two fiber optic catheters, consisting of a thin probe with a pressure transducer on the tip, were used. The first was placed at the proximal side of the ET tube and the second was positioned distally beyond the end. A low compliant air-filled catheter connected to a traditional pressure transducer was placed close to the proximal fiber optic device to compare the pressure values obtained with both systems.

Setting: The study was performed in the General Intensive Care Unit of Rome "La Sapienza", University Hospital.

Patients and participants: Seven patients admitted for the management of acute respiratory failure of different etiologies were included in the protocol. All the patients were intubated and mechanically ventilated for at least 48 h prior to the investigation.

Measurements and results: The endotracheal tube resistance was obtained both by the end-inspiratory occlusion method and measuring pressure proximally and distally to the ET tube. The measurement of respiratory mechanics was obtained proximally and distally to the ET tube. Different flows and tidal volume changes were performed. The results showed that the fiber optic device gives an adequate evaluation of airway pressure and the possibility for an easy detection of obstructions and/or deformations of the ET tube. The area described by inspiratory and expiratory pressure recorded at both sides of the ET tube showed a positive relationship between the surface and flows while no surface changes were shown when the tidal volumes were modified. Thoraco-pulmonary compliance measured proximally and distally to the ET tube gave rise to a small and statistically insignificant difference.

Conclusion: This study confirms that 48 h after the positioning of ET tubes the airflow resistance is significantly higher than might be expected from the "in vitro" data. The presence of the endotracheal tube can interfere with the evaluation of thoraco-pulmonary mechanics, particularly in dynamic conditions. The fiber optic system represents an interesting and simple tool for the evaluation of ET tube resistance and pulmonary mechanics in patients undergoing mechanical ventilation.