Leakage Characteristics of Dual-Cannula Fenestrated Tracheostomy Tubes during Positive Pressure Ventilation: A Bench Study

<div>Loss of delivered minute volume of Portex Blue Line Ultra (+), TRACOE twist (×), or Rüsch Traceofix (<svg height="8.68571pt" id="M19" style="vertical-align:-0.2063999pt" version="1.1" viewbox="-0.0498162 -8.47931 9.12938 8.68571" width="9.12938pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M674 312C674 491 527 636 346 636S19 491 19 312S165 -11 346 -11S674 133 674 312ZM616 312C616 161 495 39 346 39S77 161 77 312S197 586 346 586S616 463 616 312Z" id="g185-27"></path><glyph.data ascent="989" descent="-303" horiz-adv-x="692" vert-adv-y="692"></glyph.data></g></svg>) tracheostomy tubes plotted against transfenestration leakage rate measured at PEEP settings of 3, 6, 9, and 12 mbar. Measurements were obtained in volume-controlled ventilation (ventilator rate: 15 breaths·min<sup>−1</sup>, tidal volume: 450 mL) at <svg height="8.69875pt" id="M20" style="vertical-align:-0.3499298pt" version="1.1" viewbox="-0.0498162 -8.34882 32.3604 8.69875" width="32.3604pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M285 378C315 398 338 416 353 432C373 451 384 474 384 503C384 579 325 635 236 635H235C182 635 136 610 108 579L65 516L85 496C110 533 150 575 205 575C258 575 300 543 300 481C300 407 232 369 141 339L147 310C163 315 188 321 211 321C268 321 338 284 338 192C338 94 288 40 217 40C160 40 119 68 93 91C85 98 77 97 69 91C60 84 47 71 46 58C44 46 48 35 62 22C75 10 116 -12 162 -12C234 -12 424 62 424 224C424 297 373 359 285 376V378Z" id="g113-52"></path><glyph.data ascent="3473" descent="-2876" horiz-adv-x="480" vert-adv-y="480"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><path d="M447 623H65C61 580 56 530 47 475H76C100 541 106 550 172 550H388C308 376 196 170 91 -1L98 -12L172 -2C268 204 360 408 455 611L447 623Z" id="g113-56"></path><glyph.data ascent="3473" descent="-2876" horiz-adv-x="480" vert-adv-y="480"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,15.388,0)"><path d="M535 290V340H323V533H265V340H52V290H265V84H323V290H535ZM535 -22V28H52V-22H535Z" id="g117-37"></path><glyph.data ascent="3473" descent="-2876" horiz-adv-x="587" vert-adv-y="587"></glyph.data></g><g transform="matrix(.013,0,0,-0.013,25.924,0)"><path d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z" id="g113-50"></path><glyph.data ascent="3473" descent="-2876" horiz-adv-x="480" vert-adv-y="480"></glyph.data></g></svg>°C. Lung simulator compliance: 20 mL·mbar<sup>−1</sup>. TFLR: transfenestration leakage rate; <svg height="15.4319pt" id="M21" style="vertical-align:-6.796pt" version="1.1" viewbox="-0.0498162 -8.6359 34.9469 15.4319" width="34.9469pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M697 650H468L461 623L492 619C539 613 547 605 518 546C481 471 367 264 278 116H276C239 278 197 500 186 567C180 604 185 613 226 619L252 623L260 650H24L17 623C78 617 92 613 108 533L216 -11H247C365 200 515 462 560 529C616 612 624 615 689 623L697 650Z" id="g113-87"></path><glyph.data ascent="3473" descent="-2876" horiz-adv-x="709" vert-adv-y="709"></glyph.data></g><g transform="matrix(.0091,0,0,-0.0091,7.332,3.132)"><path d="M810 0V30C751 35 744 40 744 106V296C744 396 694 451 614 451C583 451 558 438 537 425C512 409 485 391 454 368C434 420 390 451 342 451C309 451 285 439 260 424C228 405 206 387 185 372V453C141 434 90 421 43 413V386C102 378 105 373 105 309V106C105 41 96 35 29 30V0H243V30C194 35 185 41 185 106V335C216 360 256 389 297 389C357 389 384 348 384 275V106C384 41 374 35 312 30V0H530V30C475 35 465 41 465 104V294C465 313 464 324 463 336C502 367 539 389 576 389C637 389 663 346 663 274V109C663 41 653 35 593 30V0H810Z" id="g58-107"></path><glyph.data ascent="1007" descent="-369" horiz-adv-x="834" vert-adv-y="834"></glyph.data></g><g transform="matrix(.0091,0,0,-0.0091,14.921,3.132)"><path d="M138 535C169 535 191 560 191 589C191 620 168 644 139 644S85 620 85 589C85 560 110 535 138 535ZM257 0V30C192 35 185 43 185 109V453C142 435 94 422 40 414V386C101 378 104 372 104 311V109C104 41 97 35 33 30V0H257Z" id="g58-103"></path><glyph.data ascent="1007" descent="-369" horiz-adv-x="275" vert-adv-y="275"></glyph.data></g><g transform="matrix(.0091,0,0,-0.0091,17.424,3.132)"><path d="M532 0V30C473 38 467 38 467 107V298C467 395 416 451 336 451C307 451 279 439 251 420C226 404 205 389 185 374V453C142 434 94 422 43 413V386C98 378 104 373 104 309V107C104 41 100 38 31 30V0H251V30C191 35 185 40 185 107V337C216 364 255 389 295 389C360 389 386 347 386 276V110C386 44 380 35 321 30V0H532Z" id="g58-108"></path><glyph.data ascent="1007" descent="-369" horiz-adv-x="557" vert-adv-y="557"></glyph.data></g><g transform="matrix(.0065,0,0,-0.0065,22.549,5.233)"><path d="M138 535C169 535 191 560 191 589C191 620 168 644 139 644S85 620 85 589C85 560 110 535 138 535ZM257 0V30C192 35 185 43 185 109V453C142 435 94 422 40 414V386C101 378 104 372 104 311V109C104 41 97 35 33 30V0H257Z" id="g58-103"></path><glyph.data ascent="1007" descent="-369" horiz-adv-x="275" vert-adv-y="275"></glyph.data></g><g transform="matrix(.0065,0,0,-0.0065,24.337,5.233)"><path d="M532 0V30C473 38 467 38 467 107V298C467 395 416 451 336 451C307 451 279 439 251 420C226 404 205 389 185 374V453C142 434 94 422 43 413V386C98 378 104 373 104 309V107C104 41 100 38 31 30V0H251V30C191 35 185 40 185 107V337C216 364 255 389 295 389C360 389 386 347 386 276V110C386 44 380 35 321 30V0H532Z" id="g58-108"></path><glyph.data ascent="1007" descent="-369" horiz-adv-x="557" vert-adv-y="557"></glyph.data></g><g transform="matrix(.0065,0,0,-0.0065,27.899,5.233)"><path d="M327 325C324 350 312 408 304 433C283 442 256 451 213 451C120 451 59 391 59 320C59 243 125 210 188 181C237 158 266 136 266 93C266 52 231 24 195 24C134 24 93 81 74 148L42 143C42 106 51 37 59 23C78 8 125 -12 177 -12C257 -12 345 35 345 127C345 198 292 234 216 264C171 283 131 305 131 348C131 387 156 416 195 416C243 416 277 378 297 317L327 325Z" id="g58-113"></path><glyph.data ascent="1007" descent="-369" horiz-adv-x="376" vert-adv-y="376"></glyph.data></g><g transform="matrix(.0065,0,0,-0.0065,30.31,5.233)"><path d="M173 382V461C125 442 68 425 25 418V390C88 382 92 382 92 317V-127C92 -191 84 -199 18 -204V-235H259V-204C180 -196 173 -192 173 -120V7C188 -1 212 -11 243 -12C375 12 495 109 495 261C495 361 427 451 316 451C303 451 283 446 266 435L173 382ZM173 345C200 365 243 388 274 388C346 388 409 329 409 222C409 111 353 40 266 40C231 40 196 56 173 79V345Z" id="g58-110"></path><glyph.data ascent="1007" descent="-369" horiz-adv-x="534" vert-adv-y="534"></glyph.data></g></svg>: inspiratory minute ventilation; <svg height="15.4319pt" id="M22" style="vertical-align:-6.796pt" version="1.1" viewbox="-0.0498162 -8.6359 33.1331 15.4319" width="33.1331pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M697 650H468L461 623L492 619C539 613 547 605 518 546C481 471 367 264 278 116H276C239 278 197 500 186 567C180 604 185 613 226 619L252 623L260 650H24L17 623C78 617 92 613 108 533L216 -11H247C365 200 515 462 560 529C616 612 624 615 689 623L697 650Z" id="g113-87"></path><glyph.data ascent="3473" descent="-2876" horiz-adv-x="709" vert-adv-y="709"></glyph.data></g><g transform="matrix(.0091,0,0,-0.0091,7.332,3.132)"><path d="M810 0V30C751 35 744 40 744 106V296C744 396 694 451 614 451C583 451 558 438 537 425C512 409 485 391 454 368C434 420 390 451 342 451C309 451 285 439 260 424C228 405 206 387 185 372V453C141 434 90 421 43 413V386C102 378 105 373 105 309V106C105 41 96 35 29 30V0H243V30C194 35 185 41 185 106V335C216 360 256 389 297 389C357 389 384 348 384 275V106C384 41 374 35 312 30V0H530V30C475 35 465 41 465 104V294C465 313 464 324 463 336C502 367 539 389 576 389C637 389 663 346 663 274V109C663 41 653 35 593 30V0H810Z" id="g58-107"></path><glyph.data ascent="1007" descent="-369" horiz-adv-x="834" vert-adv-y="834"></glyph.data></g><g transform="matrix(.0091,0,0,-0.0091,14.921,3.132)"><path d="M138 535C169 535 191 560 191 589C191 620 168 644 139 644S85 620 85 589C85 560 110 535 138 535ZM257 0V30C192 35 185 43 185 109V453C142 435 94 422 40 414V386C101 378 104 372 104 311V109C104 41 97 35 33 30V0H257Z" id="g58-103"></path><glyph.data ascent="1007" descent="-369" horiz-adv-x="275" vert-adv-y="275"></glyph.data></g><g transform="matrix(.0091,0,0,-0.0091,17.424,3.132)"><path d="M532 0V30C473 38 467 38 467 107V298C467 395 416 451 336 451C307 451 279 439 251 420C226 404 205 389 185 374V453C142 434 94 422 43 413V386C98 378 104 373 104 309V107C104 41 100 38 31 30V0H251V30C191 35 185 40 185 107V337C216 364 255 389 295 389C360 389 386 347 386 276V110C386 44 380 35 321 30V0H532Z" id="g58-108"></path><glyph.data ascent="1007" descent="-369" horiz-adv-x="557" vert-adv-y="557"></glyph.data></g><g transform="matrix(.0065,0,0,-0.0065,22.549,5.233)"><path d="M384 109C349 76 310 59 268 59C197 59 123 113 120 245C240 248 367 259 384 262C403 266 407 275 407 296C407 376 338 451 254 451H253C201 451 148 425 105 378C65 334 39 272 39 203C39 88 112 -12 235 -12C266 -12 339 5 402 84L384 109ZM230 411C285 411 319 365 319 313C319 298 313 293 294 293C236 291 180 290 125 290C141 370 185 411 230 411Z" id="g58-99"></path><glyph.data ascent="1007" descent="-369" horiz-adv-x="434" vert-adv-y="434"></glyph.data></g><g transform="matrix(.0065,0,0,-0.0065,25.37,5.233)"><path d="M482 0V30C420 38 407 48 370 103L273 248C308 299 331 332 352 357C387 397 401 404 463 409V439H277V409C318 405 324 400 307 369C290 337 270 307 251 279L194 367C175 396 180 402 220 409V439H18V409C74 401 87 395 117 349L204 213C173 168 147 130 119 95C78 46 67 38 5 30V0H195V30C144 38 143 47 162 79C181 112 202 149 225 181L297 70C314 43 307 35 264 30V0H482Z" id="g58-118"></path><glyph.data ascent="1007" descent="-369" horiz-adv-x="481" vert-adv-y="481"></glyph.data></g><g transform="matrix(.0065,0,0,-0.0065,28.503,5.233)"><path d="M173 382V461C125 442 68 425 25 418V390C88 382 92 382 92 317V-127C92 -191 84 -199 18 -204V-235H259V-204C180 -196 173 -192 173 -120V7C188 -1 212 -11 243 -12C375 12 495 109 495 261C495 361 427 451 316 451C303 451 283 446 266 435L173 382ZM173 345C200 365 243 388 274 388C346 388 409 329 409 222C409 111 353 40 266 40C231 40 196 56 173 79V345Z" id="g58-110"></path><glyph.data ascent="1007" descent="-369" horiz-adv-x="534" vert-adv-y="534"></glyph.data></g></svg>: expiratory minute ventilation.</div>

Anesthesiology Research and Practice

fig6

Figure 6

Figure 6: Leakage Characteristics of Dual-Cannula Fenestrated Tracheostomy Tubes during Positive Pressure Ventilation: A Bench Study 