Clamping an ET tube?

[Aussieaid]

Ok, I guess I and a number of other people who I know have both seen and done this procedure must have been sharing too much of something good (and potent)!

Just from a quick search of "Google-pedia":

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[PDF]

Pulmonary Management of Severe Respiratory Failure

- Jan 15

File Format: PDF/Adobe Acrobat - Quick View

Injury to the lung parenchyma causes a loss of FRC, a .... patient, there will not be adequate lung volume. Perform a recruitment maneuver. Return to HFOV settings ... prevent overdistention injury. mPaw at optimal PEEP maintains alveolar .... leak if present, and clamp the endotracheal tube with padded clamp ...

www.conferencebythesea.net/2010_lectures/Kriner_HFOV.pdf

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Prone Position Augments Recruitment and Prevents Alveolar ...

- Jan 15

by E Galiatsou - 2006 - Cited by 47 - Related articles

The apnea at FRC was achieved by clamping the endotracheal tube with a ..... with low tidal volumes might further increase the loss of lung aeration. ...

ajrccm.atsjournals.org/cgi/content/full/174/2/187 - Similar

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Open Lung Tool and Lung Recruitment Workshop 203

This procedure may need to be repeated anytime there is a loss of ... Care should be taken to clamp the ET tube to prevent lung collapse. ...

www.mecriticalcare.net/lectures.php?cat_id=&download_id=50

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[PDF]

Alveolar recruitment during prone position: time matters

File Format: PDF/Adobe Acrobat - Quick View

by J REUTERSHAN - 2006 - Cited by 11 - Related articles

regression between lung recruitment and changes in the ..... An initial loss of PEEP was avoided by clamping the endotracheal tube before disconnecting it ...

www.clinsci.org/cs/110/0655/1100655.pdf

[PPT]

Tahoe Critical Care Conference

- Jan 14

File Format: Microsoft Powerpoint - View as HTML

The Open Lung Tool protocol is a lung recruitment and best PEEP protocol. ... This procedure may need to be repeated anytime there is a loss of PEEP or a ventilator ... Care should be taken to clamp the ET tube to prevent lung collapse. ...

www.rcsw.org/.../Presentation%202006%20RCSW%20Open%20Lung%20Tool%20in... - Similar

Presentation 2006 RCSW Open Lung Tool in Recruitme Ppt Presentatio..

Feb 14, 2008 ... The Open Lung Tool protocol is a lung recruitment and best PEEP protocol. ... This procedure may need to be repeated anytime there is a loss of PEEP ... Care should be taken to clamp the ET tube to prevent lung collapse. ...

www.authorstream.com/.../Lassie-50285-Presentation-2006-RCSW-Open-Lung-Tool-Recruitme-Pacific-NW-Regional-Respiratory-Car... - Cached - Similar

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DF]

morton_ch25[1] - Patient Management: Respiratory System

File Format: PDF/Adobe Acrobat - Quick View

by DL CHARLEBOIS - Cited by 1 - Related articles

is attributed to recruitment of collapsed lung areas.5 ... is to promote lung expansion and prevent aspiration that ..... tracheostomy or endotracheal tube. Respiratory failure ..... be used to avoid loss of PEEP and desaturation. ..... end of the tube is clamped with the hemostat and then ...

www.medic94.com/CCEMTP/morton_ch25%5B1%5D.pdf

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Clinical Science (2004) 106, 3-10 - J. Reutershan and others - Non ...

by J REUTERSHAN - 2004 - Cited by 7 - Related articles

The endotracheal tube was clamped at end-expiration in order to avoid a loss ... PBF measurement to avoid loss of PEEP and subsequent alveolar derecruitment ..... (2002) Recruitment maneuvers during lung protective ventilation in acute ...

www.clinsci.org/cs/106/0003/cs1060003.htm - Cached

Now I can understand people being uncomfortable doing this and that is not a bad thing. Not having done that much of a study on it there seems to be some different opinions even on the best time to do it (end inspiratory or end expiratory). I think there is more risk of breath stacking with end inspiratory but I was taught to do it at end inspiratory so that is the method I use.

The conundrum of not clamping in a critically ill patient is that that is the only patient that I would even consider doing it on. I rarely do it outside of the hospital setting but when I do it is on the pt who doesn't tolerate that loss of PEEP and lung de-recruitment. That is the rationale: to prevent loss of PEEP and lung de-recruitment.

There are definitely times I would like to have a pocket Dr as well as a pocket mechanic however that is just not possible.

Ultimately if you are not comfortable with or have never heard or seen a procedure done before than absolutely don't do it. However if you don't open up your mind to new ideas, techniques, practices, etc, than you are not doing yourself any favors and your professional growth will eventually be stunted.

Edited January 18, 2011 by Aussieaid

[tniuqs]

Ok, I guess I and a number of other people who I know have both seen and done this procedure must have been sharing too much of something good (and potent)!

Just from a quick search of "Google-pedia":

#

Now I can understand people being uncomfortable doing this and that is not a bad thing.

There are definitely times I would like to have a pocket Dr as well as a pocket mechanic however that is just not possible.

Ultimately if you are not comfortable with or have never heard or seen a procedure done before than absolutely don't do it. However if you don't open up your mind to new ideas, techniques, practices, etc, than you are not doing yourself any favors and your professional growth will eventually be stunted.

Well I have been called stunned but a first for stunted, although that is something I will now look forward too in my old age. I am commonly called skeptical and actually enjoy that.

I would like to point out in all these presentations (and 2 thumbs up for finding them, some interesting presentations here, but are all USA based and thing is in other countries they may be considered retarded I guess ?

ALL these patient were extremely ill and the vast majority of the discussion/ presentations are "focused" on lung recruitment techniques, ventilation with HFO, Proneing and critical care ONLY.

I still have yet to see or even hear of TUBE Clamping in my hood, but rest assured that I will be asking at next RT conference in Alberta after APRV and ECCMO presentations.

There are things discussed in these studies as in determining "closing lung volumes" (why I do not know) either unless research data was to be obtained only, as this would result in lung de recruitment in itself and then dropping cuff pressure to allow for CO2 removal in the HFO patient and those are research level issues also, you have opend my eyes to this but I am yet to be convinced that TUBE CLAMPING is anywhere near proven or an acceptable practice.

I commend you in your fact finding tour but I can not accept that and "especially" in EMS that clamping any ETT is advisable nor proven to be an effective in way of preventing lung de recruitment if it WERE then one should NEVER suction a patient as this would subject the patient to negative pressures of you see where I am going with this.

This crowd COULD stand to improve the understanding of the effects of CPAP vs PEEP, (what patient demographic pathology would benifet in the EMS field) CPAP vs BI Level support, (controversy's) interpretation of ABGs, understanding O2 transport and what is ETCO2 and SPO2 really telling you or the interactions of different parameters changes in conventional ventilation, as a matter of priority ... oddly enough as soon as I make one "wordy" post on these topics ... the silence is overwhelming.

cheers

edit for quotes no contextual changes

Edited January 18, 2011 by tniuqs