Efficacy of coaxial ventilation with a novel endotracheal catheter equipped with a functional cuff: A swine model study

BACKGROUND: We have developed an endotracheal catheter with a functional cuff (ECFC) that inflates during inspiration and deflates during expiration. This catheter, together with a regular ICU ventilator, can provide coaxial ventilation. OBJECTIVE: The aim of this study was to determine the efficacy of ventilation in adult human-sized swine using an ECFC and a regular ICU ventilator. DESIGN: A prospective animal study. SETTING: Experimental, Trauma Transplant Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA. ANIMALS: Eight adult Yorkshire swine, weighing 45 to 50 kg, were studied. INTERVENTIONS: To create the ECFC, a 5 cm long latex cuff was placed over the distal side ports of either a 14 or 19-Fr gauge endotracheal catheter and a 1 cm long piece of plastic tube was inserted into the tip of the endotracheal catheter to create an internal resistance. The ECFC was placed into the trachea and the proximal end of the ECFC was connected to an ICU ventilator in pressure-control mode, with peak pressures set at either 25, 50 or 70 cmH2O. MAIN OUTCOME MEASURES: Tidal volume was calculated using plethysmography. RESULTS: During pressure control ventilation with the 14-Fr gauge ECFC at set inspiratory pressures of 25, 50 and 75 cmH2O, the tidal volumes generated were 209 ± 36, 309 ± 61 and 367 ± 85 ml, respectively, and with the 19-Fr gauge ECFC these were 277 ± 51, 442 ± 91 and 538 ± 123 ml, respectively. No complications were observed. CONCLUSION: An ECFC combined with a regular pressure-controlled ICU ventilator can produce adequate tidal volumes in adult human-sized swine. Our results establish the feasibility of ventilation with this new alternative technique. The safety and advantages of such a technique remain to be determined in humans.

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