Bench testing of tracheostomy tube-related insults using an instrumented manikin

Abstract

Purpose: Choosing the right tracheal tube for the right patient is a daily preoccupation for intensivists and emergency physicians. Tracheal tubes can generate severe complications, which are chiefly due to the pressures applied by the tube to the trachea. We designed a bench study to assess the frequency of pressure levels likely to cause tracheal injury.

Methods: We tested the pressure applied on the trachea by 17 tube models of a given size range. To this end, we added a pressure sensor to the posterior tracheal wall of a standardized manikin.

Results: Only 2 of the 17 tubes generated pressures under the threshold likely to induce tracheal injury (30 mmHg/3.99 kPa). The force exerted on the posterior wall of the trachea varied widely across tube models.

Conclusion: Most models of tracheal tubes resulted in forces applied to the trachea that are usually considered capable of causing tracheal tissue injury.

Level of evidence: Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence: How common is the problem?: step 1; Is this diagnostic or monitoring test accurate? (Diagnosis) step 5; What will happen if we do not add a therapy? (Prognosis) n/a; Does this intervention help? (Treatment Benefits) step 5; What are the COMMON harms?(Treatment Harms) step 5; What are the RARE harms? (Treatment Harms) step 5; Is this (early detection) test worthwhile? (Screening) step 5.

Keywords: Pressure-induced injury; Tracheal cannula; Tracheal injury; Tracheal tube; Tracheostomy.