Endotracheal tube leaks: generally minor, but occasionally dangerous

Introduction: Leaks around endotracheal tubes (ETT) pose risks to intubated patients that include inadequate ventilation, pulmonary aspiration, and the stress of additional laryngascopy and re-intubation^1,2. In this study, we examined the patient, ventilator, and ETT factors associated with ETT leaks in two surgical ICU's. Methods: Twenty eight orally or nasally intubated patients were enrolled over a 2-month period in an IRB-approved, observational study. Sixteen patients had ETT leaks (Group L) defined as loss of tidal volume (detectable by audible flow and oral secretions). Twelve patients were randomly selected controls (Group C). Clinical data collected included patient demographics, duration of intubation (Tintub), vital signs, ventilator parameters, static compliance (Cstat), use of sedatives or muscle relaxants, and ETT tip to carina distance (Ett-C dist) measured on chest x-ray. The method of ETT leak management and short-term patient outcomes were recorded. Continuous data are presented as mean ± SD. Statistical analyses included square, t-test, and ANOVA logistic regression with p<0.05 accepted as significant. Results: Patients demographic data and vital signs in both Group L (n=16) and Group C (n=12) showed no statistically significant differences. Patients requiring sedation were at a significantly higher risk for developing ETT leakage (odds ratio=22, p<0.003). In addition, ETT leaks were significantly correlated to duration of intubation (p<0.02), but not to static compliance (Cstat) or peak inspiratory pressure (PIP). There was no statistically significant difference in mechanical ventilatory modes, minute ventilation (MV), PIP, positive end-expiratory pressure (PEEP), or ETT cuff pressure between the two groups. Of the 10 leaks recorded, all but one resolved with ETT cuff reinflation. One leak resulted in an airway-related complication: hypventilation with hypoxia due to damage to the ETT cuff pilot line, thus requiring ETT replacement. Conclusions: Of all patient, ventilator, and ETT-related factors studied, only the Tintub was significantly associated with ETT leaks. Patients requiring sedation were at a significantly higher risk of developing leaks. Leak-specific morbidity was 6% (1/16). More than 90% of leaks were resolved with simple ETT cuff reintiation. Ventilator/ETT Parameters Group L (n=16) Group C (n=12) MV (set) 8.5 ± 2.7 8.4 ± 3.3 MV (spontaneous) 11.0 ± 7.1 11.5 ± 4.1 RR (tot) 20.3 ± 5.8 16.3 ± 6.2 Cstat 40.4 ± 20.9 50.2 ± 26.2 PIP 32.5 ± 10.9 28.4 ± 9.5 PEEP 5.9± 1.6 6.7 ± 4.4 Cuff press (cmH20) 23.3±7.9 19.7 ± 2.9 ETT-C dist (cm) 3.2 ± 1.7 4.3 ± 1.2 T intub (days) 6.1 ± 5.4 * 2.5 ± 3.7 * * p=0.01 Data represent means ± S.D.