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Continuous calculation of intratracheal pressure in the presence of pediatric endotracheal tubes

Objective: To measure the pressure‐flow relationship of pediatric endotracheal tubes (ETTs) in trachea models, to mathematically describe this relationship, and to evaluate in trachea/lung models a method for calculation of pressure at the distal end of the ETT (Ptrach) by subtracting the flow‐dependent pressure drop across the ETT from the airway pressure measured at the proximal end of the ETT. Design: Trachea models and trachea/lung models. Setting: Research laboratory in a university medical center. Interventions: The pressure‐flow relationship of pediatric ETTs (inner diameter, 2.5‐6.5 mm) was determined using a physical model consisting of a tube connector, an anatomically curved ETT, and an artificial trachea. The model was ventilated with sinusoidal gas flow (12‐60 cycles/min). The coefficients of an approximation equation considering ETT resistance and inertance were fitted separately to the measured pressure‐flow curves for inspiration and expiration. Calculated Ptrach was compared with directly measured Ptrach in mechanically ventilated physical trachea/lung models. Measurements and Main Results: The pressure‐flow relationship was considerably nonlinear and showed hysteresis around the origin caused by the inertia of accelerated gas. ETT inertance ranged from 0.1 to 0.4 cm H2O/L·sec2 (inner diameter, 6‐2.5 mm). The abrupt change in cross‐sectional area at the tube connector caused an inspiration‐to‐expiration asymmetry. Calculated and measured Ptrach were within ± 1 cm H2O. Correspondence between measured and calculated Ptrach is improved even further when the ETT inertance is taken into account. Conclusions: Ptrach can continuously be monitored in the presence of pediatric ETT by combining ETT coefficients and the flow and airway pressure continuously measured at the proximal end of the ETT.