Relationship between endotracheal tube leakage and under-reading of tidal volume in neonatal ventilators

Aim:  Protective ventilation in neonates requires careful volume monitoring to prevent ventilator‐induced lung injury caused by baro/volutrauma and hence chronic lung disease. This study investigated the effect of endotracheal tube (ET) leakage on the displayed tidal volume using an in vitro model....

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Bibliographic Details
Published in:Acta Paediatrica 2009-07, Vol.98 (7), p.1116-1122
Main Authors: Mahmoud, RA, Fischer, HS, Proquitté, H, Shalaby, HM Abudaif, Schmalisch, G
Format: Article
Language:English
Subjects:
Biological and medical sciences
Continuous Positive Airway Pressure - instrumentation
Endotracheal leaks
General aspects
Humans
Infant, Newborn
Intubation, Intratracheal - adverse effects
Intubation, Intratracheal - instrumentation
Mechanical ventilation
Medical sciences
Models, Biological
Monitoring, Physiologic - instrumentation
Multivariate Analysis
Neonates
Pulmonary Ventilation
Respiratory Mechanics
Tidal volume
Tidal Volume - physiology
Ventilator-Induced Lung Injury - prevention & control
Ventilators, Mechanical - adverse effects
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Summary:Aim:  Protective ventilation in neonates requires careful volume monitoring to prevent ventilator‐induced lung injury caused by baro/volutrauma and hence chronic lung disease. This study investigated the effect of endotracheal tube (ET) leakage on the displayed tidal volume using an in vitro model. Methods:  A neonatal lung model was ventilated via a 3 mm ET using three ventilators [Babylog 8000 (BL), Leoni (LE) and Stephanie (ST)]. Tidal volume was measured by each ventilator at the Y‐piece and by a pneumotach (CO2SMO+) in the model. ET leaks were simulated by open tubes of different lengths. PIP (20 cmH2O) and PEEP (5 cmH2O) were kept constant, and the respiratory rate (RR) was varied between 20/min and 70/min (Ti:Te = 1:1). Results:  Tidal volume displayed by a ventilator decreased independently of RR with increasing leakage up to 21% (BL), 30% (LE) and 33% (ST). However, the volume delivered to the lung was nearly constant. The displayed leakage varied between 0 and 78% and was dependent on RR and leakage resistance. There were distinct differences between the three ventilators in the relationship between displayed leakage and volume error. Accepting a volume error
ISSN:0803-5253
1651-2227
DOI:10.1111/j.1651-2227.2009.01319.x