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Effectiveness of substantial shortening of the endotracheal tube for decreasing airway resistance and increasing tidal volume during pressure-controlled ventilation in pediatric patients: a prospective observational study

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Abstract

The endotracheal tubes (ETTs) used for children have a smaller inner diameter. Accordingly, the resistance across ETT (RETT) is higher. Theoretically, shortening the ETTs can decrease total airway resistance (Rtotal), because Rtotal is sum of RETT and patient’s airway resistance. However, the effectiveness of ETT shortening for mechanical ventilation in the clinical setting has not been reported. We assessed the effectiveness of shortening a cuffed ETT for decreasing Rtotal, and increasing tidal volume (TV), and estimated the RETT/Rtotal ratio in children. In anesthetized children in a constant pressure-controlled ventilation setting, Rtotal and TV were measured with a pneumotachometer before and after shortening a cuffed ETT. In a laboratory experiment, the pressure gradient across the original length, shortened length, and the slip joint alone of the ETT were measured. We then determined the RETT/Rtotal ratio using the above results. The clinical study included 22 children. The median ETT percent shortening was 21.7%. Median Rtotal was decreased from 26 to 24 cmH2O/L/s, and median TV was increased by 6% after ETT shortening. The laboratory experiment showed that ETT length and the pressure gradient across ETT are linearly related under a certain flow rate, and approximately 40% of the pressure gradient across the ETT at its original length was generated by the slip joint. Median RETT/Rtotal ratio were calculated as 0.69. The effectiveness of ETT shortening on Rtotal and TV was very limited, because the resistance of the slip joint was very large.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 1–1, Seiryomachi, Aoba–Ku, Sendai, 980–8574, Japan

    Kazuhiro Takahashi, Hiroaki Toyama, Ryosuke Kubo, Norifumi Yoshida & Masanori Yamauchi

  2. Division of Surgical Center and Supply, Sterilization, Tohoku University Hospital, 1–1, Seiryomachi, Aoba-Ku, Sendai, 980–8574, Japan

    Yutaka Ejima

  3. Department of Finemechanics, Graduate School of Engineering, Tohoku University, 6–6–01, Aramaki Aza Aoba, Aoba–ku, Sendai, 980-8579, Japan

    Kenji Kikuchi

  4. Graduate School of Biomedical Engineering, Tohoku University, 6–6–01, Aramaki Aza Aoba, Aoba-ku, Sendai, 980–8579, Japan

    Takuji Ishikawa

Authors
  1. Kazuhiro Takahashi
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection and analysis were performed by KT, HT, RK, and NY. Data analysis were performed by KT, HT, YE, KK, and TI. The study was supervised by MY. The first draft of the manuscript was written by KT and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Hiroaki Toyama.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Tohoku University Graduate School of Medicine (Date; November 16, 2020/No; 2020-1-727).

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Written informed consent was obtained from the parents of all participants.

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Takahashi, K., Toyama, H., Kubo, R. et al. Effectiveness of substantial shortening of the endotracheal tube for decreasing airway resistance and increasing tidal volume during pressure-controlled ventilation in pediatric patients: a prospective observational study. J Clin Monit Comput 37, 1513–1519 (2023). https://doi.org/10.1007/s10877-023-01038-w

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