Endotracheal Tube Size Is Associated With Mortality in Patients With Status Asthmaticus

Area of Science:

• Critical Care Medicine
• Pulmonology
• Emergency Medicine

Background:

• Limited evidence exists regarding the clinical significance of endotracheal tube (ETT) size selection in patients with status asthmaticus requiring mechanical ventilation.
• Status asthmaticus is a severe form of asthma that can necessitate invasive airway management.

Purpose of the Study:

• To investigate the association between different endotracheal tube (ETT) internal diameter sizes and clinical outcomes in mechanically ventilated patients with status asthmaticus.
• To explore the impact of ETT size on in-hospital mortality in this specific patient population.

Main Methods:

• Retrospective study analyzing data from 964 adult status asthmaticus admissions between 2014-2021.
• Comparison of in-hospital mortality between non-intubated subjects and intubated subgroups based on ETT size (≤7 mm, ≤7.5 mm, ≥8 mm).
• Logistic and generalized linear mixed-effects models were used for analysis, adjusting for demographics, comorbidities, organ failure scores, and other clinical factors.

Main Results:

• Intubated patients with status asthmaticus exhibited higher mortality compared to non-intubated patients.
• A dose-response relationship was observed, with incrementally higher mortality associated with smaller ETT sizes (e.g., adjusted mortality was 26.7% for ETT ≤ 7 mm vs. 11.0% for ETT ≥ 8 mm).
• Specific adjusted mortality rates were 26.7% (95% CI 13.2-40.2) for ETT ≤ 7 mm, 14.3% (95% CI 6.9-21.7%) for ETT ≤ 7.5 mm, and 11.0% (95% CI 4.4-17.5%) for ETT ≥ 8 mm.

Conclusions:

• Intubated patients with status asthmaticus have a poorer prognosis than their non-intubated counterparts.
• Smaller endotracheal tube sizes in intubated status asthmaticus patients are linked to increased mortality.
• Physiologic mechanisms likely underlie the observed dose-response relationship between ETT size and mortality.