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Breathing through a straw: fact or fiction?

Egging, R.M. and Woerds, D.K.M. ter and Merkerk, M.N. van and Hanegraaf, J.P.B. (2018) Breathing through a straw: fact or fiction?

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Abstract:INTRODUCTION: For pediatric patients on the intensive care who are mechanically ventilated, it is of major importance that extubation is performed at the right moment. This is because extubation failure is independently associated with a five-fold increased risk of complications and mortality in pediatric patients. It would be an advantage to determine whether the patient is capable of spontaneous breathing, before extubation is performed. A solution could be to first let a patient breathe spontaneously through the ETT, when disconnected from the mechanical ventilator. OBJECTIVE: The aim of this study is to quantify the WOBimp during spontaneous breathing through a pediatric endotracheal tube. METHOD: A set-up with a test lung consisting of a cylindrical stepper motor was used to simulate spontaneous breathing. A total of 112 measurements were performed to obtain data to calculate the WOBimp in eleven tubes with different diameters, tubes with a catheter inserted and shortened tubes. At both ends of the tube, a pressure and flow sensor was placed. The collected data was used to calculate the WOBimp. RESULTS: The WOBimp increases for larger tidal volumes and decreases when larger tube diameters are used. The WOBimp does not exceed the clinically assumed acceptable value of 1.0 J/l, except for the 3.5 mm tube with the largest tidal volume. When compared to standard tube sizes, a significant decrease in WOBimp, ranging from 2.7 % to 32.5%, can be seen in the shortened ETTs. A significant increase in WOBimp can be seen in the tubes in which a catheter was inserted, ranging from 89.0% to 291.5% for the 3.0 and 3.5 mm tubes and from 19.5% to 95.3% for the other tubes. CONCLUSION: The WOBimp does not exceed the clinically assumed acceptable value of 1.0 J/l, except for the 3.5 mm tube with the largest tidal volume. When compared to standard tube sizes, a significant decrease in the WOBimp is seen when the tubes are shortened and a significant increase in WOBimp can be seen in the tubes in which a catheter was inserted. RECOMMENDATIONS: Further research is needed to validate the reference value of 1.0 J/l for the maximum WOBimp. This research should eventually also be performed in an in vivo setting to determine an appropriate maximum for WOBimp.
Item Type:Essay (Bachelor)
Clients:
Universitair Medisch Centrum Groningen, Groningen, Nederland
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine BSc (50033)
Link to this item:http://purl.utwente.nl/essays/74497
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