MASSIVE AIRWAY LEAKS - AN ANALYSIS OF THE ROLE OF ENDOTRACHEAL-TUBES

Objective: To determine the abnormalities present in endotracheal tubes removed from mechanically ventilated patients for ''massive airleak.'' ''Massive airleak'' was defined as a leak that the attending physician felt was indicative of endotracheal tube defect such that extubation (and reintubation, if needed) would be indicated. Design: Prospective, observational study. Setting. Mixed medical-surgical intensive care unit at a community teaching hospital. Patients: Seventeen patients among 1,082 patients who were undergoing mechanical ventilation during the study period. Interventions: Authors were not involved in the evaluation of most airleak situations and most participating physicians were unaware of the study. All physicians involved were board certified in pulmonary, critical care, emergency medicine, or anesthesiology. Removed endotracheal tubes were grossly inspected and subjected to pneumatic stress to determine the sites of the leakage. Measurements and Main Results. Eighteen endotracheal tubes were examined over a 2-yr period. Of these tubes, 11 (61%) had no evidence of mechanical fault. Five (28%) tubes had defects in the tracheal cuff and two (11%) tubes had abnormalities of the pilot valve apparatus. Condensation within the pilot valve cuff was present in 14 of 18 tubes and was present in ten of 11 intact tubes. Although the study population had an equal number of orally and nasally placed endotracheal tubes, intact tubes were disproportionately oral (8/11) and tubes with cuff leaks were predominantly nasal (4/5) (p = .038). Conclusions. A large number of endotracheal tubes removed for presumed defect are flawless. The authors speculate that tube malposition is the most likely explanation for this phenomenon. Our findings suggest that patients are might improve with more meticulous daily attention to the airway, as well as a more analytical rather than action-oriented approach to the leaking endotracheal tube.