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Physiological effects of translaryngeal open ventilation in patients with restrictive respiratory disorders
Cesare Gregoretti1, Paolo Navalesi, Piera Biolino
1Servizio di Anestesia e Rianimazione - CTO, Via Zuretti 29, 101028 Torino, Italy. 3358394262@tim.it
Objective:
To compare the efficacy of pressure-controlled ventilation (PCV) delivered through a conventional endotracheal tube with the same ventilatory mode using a small-size tube with the cuff left deflated (translaryngeal open ventilation: TLOV).
Setting:
A medical-surgical intensive care unit (ICU).
Design:
Prospective physiological study.
Patients:
Thirteen consecutive patients with restrictive neuromuscular and thoracic respiratory disorders ventilated in pressure-controlled mode.
Interventions:
The standard tube was removed and a microlaryngeal tube (i.d. 4 mm, o.d. 6 mm, length 380 mm) was inserted with the cuff left deflated. PCV was increased to match the tracheal pressure measured during conventional ventilation. Arterial blood gases were measured before, 1 h and 20 h after initiating TLOV. A patient comfort score was measured by a visual analogue scale during conventional ventilation and 20 h after initiating TLOV (0= very bad, 1= bad, 2= quite bad, 3= sufficient, 4= good, and 5= very good).
Results:
Inspiratory pressure was significantly increased from 16+/-5 cmH(2)O to 68+/-13 cmH(2)O after 1 h and to 65+/-12 cmH(2)O after 20 h to match the tracheal pressure measured during conventional ventilation (CV) (p<0.005). No statistically significant differences were found in arterial blood gases and patient's respiratory rate before and after 1 and 20 h of TLOV. The comfort score was 1.3+/-0.4 and 3.6+/-0.4 during CV and TLOV, respectively, on a scale from 0 to 5 (p<0.002).
Conclusion:
This study indicates that, in selected patients, TLOV was as efficient as conventional PCV.
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