Endotracheal tubes and imposed work of breathing what should we do about it, if anything.docVIP

Available online /content/7/5/347 Commentary Endotracheal tubes and imposed work of breathing: what should we do about it, if anything? Richard D Branson Associate Professor of Surgery, University of Cincinnati, Cincinnati, Ohio, USA Correspondence: Richard D Branson, Richard.Branson@UC.edu Published online: 28 August 2003 Critical Care 2003, 7:347-348 (DOI 10.1186/cc2367) This article is online at /content/7/5/347 ? 2003 BioMed Central Ltd (Print ISSN 1364-8535; Online ISSN 1466-609X) Abstract Concerns about the work of breathing imposed by the endotracheal tube have led clinicians to routinely use pressure support to overcome this resistive component. More recently, ventilator manufacturers have introduced systems to automatically overcome endotracheal tube resistance, regardless of tube diameter or patient demand for flow. Despite the theoretical advantages, neither method appears to provide superior performance. Stepping back, the real question may be, is overcoming endotracheal tube resistance really important? Keywords endotracheal tube, mechanical ventilation, tube compensation, work of breathing Techniques and equipment to accomplish endotracheal (ET) intubation were the precursor to modern day invasive mechanical ventilation. In recent years, however, the popularity of the ET tube has waned. Clinically, the ET tube is seen as an impediment to spontaneous breathing, a transit route for bacteria to the lower airway, and – with the advent of noninvasive ventilation – a device to be avoided when possible. Of particular interest has been the effect of the ET tube on work of breathing and methods to eliminate this work. Commonly, pressure support ventilation (PSV) has been suggested as the technique of choice for eliminating imposed work due to the ET tube. More recently, the technique of automatic tube apparent untoward effects. In fact, the routine use of spontaneous breathing trials today supports this conce