Christopher Chou, MD,
Resident Physician
Virginia Commonwealth University Health System
Disclosure information not submitted.
Yub Raj Sedhai, MD
MD
Virginia Commonwealth University, United States
Disclosure information not submitted.
Curtis Sessler, MD, FCCM
Director, Center for Adult Critical Care
Virginia Commonwealth University Health System
Richmond, Virginia, United States
Disclosure information not submitted.
Arjun Mohan, MD
PCCM Physician
Virginia Commonwealth University, United States
Disclosure information not submitted.
Matthew Churpek, MD, MPH, PhD
ICU Physician
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin, United States
Disclosure information not submitted.
Casey Cable, MD Msc
Associate Director or Resource Intensivist Program
VCU Health, United States
Disclosure information not submitted.
Markos Kashiouris, MD, MPH
Director of Resource Intensivist Program
Virginia Commonwealth U Medical Ctr, United States
Disclosure information not submitted.
Title: Small Endotracheal Tube Diameter Is Associated With Higher Mortality in Status Asthmaticus
Introduction: There is limited evidence around the clinical significance of the endotracheal tube (ETT) size selection in patients with status asthmaticus who require invasive ventilation. We set out to explore the clinical outcomes of differential ETT internal diameter size selection in patients ventilated with status asthmaticus.
Methods: This is a retrospective case-control study of invasively mechanically ventilated patients with status asthmaticus in a tertiary care academic center from 2014 to 2021. We examined in-hospital mortality across subgroups with different ETT sizes and produced logistic and generalized linear mixed models. In addition, we adjusted for demographics, Elixhauser comorbidities, the first sequential organ failure assessment (SOFA) score, the first PaCO2. Finally, we calculated the post-estimation predictions of mortality.
Results: We enrolled patients from 1,111 status asthmaticus admissions: Six point six percent (74) had a 7.0 mm or smaller ETT (ETT7 group), 16.6% (184) a 7.5 mm ETT (ETT7.5 group), 16.7% (163) an 8.0 mm or larger ETT (ETT8 group), and 62.1% (690) were not intubated. The unadjusted ETT7 mortality was 25.7% vs. 14.7% (95% CI 9.5 - 19.8%, p=0.04) for the ETT7.5, and 18.4% (95% CI 12.5 - 24.4%, p=0.2) for the ETT8 group respectively. The severity adjusted mortality was 21.4% (95% CI 13.1- 29.8%) for the ETT7 group vs. 12.7% (95% CI 8.1 – 17.4%, p=0.01) for ETT7.5, and 9.8% (95% CI 5.5 – 14.1%, p=0.01) for ETT8 group respectively.
Conclusions: This study reports incrementally higher mortality in patients with status asthmaticus who had received incrementally smaller ETT sizes. Physiologic mechanisms can support this dose-response relationship. However, future multicenter studies are needed to interrogate and externally validate these findings.