A Comparison of a New, Ultrathin-Walled Two-Stage Twin Endotracheal Tube and a Conventional Endotracheal Tube in Very Premature Infants with Respiratory Distress Syndrome: A Pilot Study

 

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ABSTRACT

This was a pilot study to test the feasibility of use of the ultrathin-walled two-stage twin endotracheal tube (UTTS-T-ETT), with one half to one third the resistance to gas flow and one third to one seventh the dead space of a conventional tracheal tube, in very premature infants. Twenty-eight infants with gestational age 24 to 28 weeks and birthweight ≥ 500 g with respiratory distress syndrome requiring intubation and mechanical ventilation were randomly assigned to be intubated with either the UTTS-T-ETT (13 infants) or with a conventional ETT (15 infants). The infants in the two groups were similar in GA, birthweight, age of entry in the study, and initial ventilator settings. Indications for intubation and extubation were standardized. To evaluate the feasibility of the UTTS-T-ETT, complications with insertion of the endotracheal tube, traumatic injury of the upper airway, number of accidental extubations, number of re-intubations after attempted extubation, number of x-ray/days of mechanical ventilation, prevalence of atelectasis, prevalence of air-leak syndrome, duration of ventilation, bronchopulmonary dysplasia, length of stay, and mortality in the two groups were compared. No significant differences in the outcomes were observed. Specifically, no complications during intubation or traumatic injury of the upper airway due to indwelling ETT were observed in either group. The proportion of failed extubation attempts was 7% in the UTTS-T-ETT v 40% in the conventional ETT group (p = 0.08). The use of the UTTS-T-ETT is feasible in preterm infants. There was no difference in adverse events associated with its use compared with a conventional ETT. Given the proven in vitro advantages and a favorable trend toward facilitation of extubation in this pilot study, a larger randomized trial to assess clinical benefit and confirm safety is indicated.

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Elvira ParraviciniM.D. 

Assistant Professor of Clinical Pediatrics, Department of Pediatrics, College of Physicians & Surgeons, Columbia University and Morgan Stanley Children's Hospital of New York-Presbyterian

3959 Broadway, CHN 1213, New York, NY 10032