Contribution of the Endotracheal Tube and the Upper Airway to Breathing Workload

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Abstract
The influence of the endotracheal tube (ETT) during a T-piece trial remains controversial. Our aim was to compare the work of breathing of 14 successfully extubated patients at the end of a 2-h trial (T) and after extubation (E) of the trachea, and to assess, using the acoustic reflection method, the resistance of the endotracheal tube and of the supraglottic airway as well as their related work. We found that the work of breathing of the patients was identical between T and E (1.72 ± 0.59 versus 1.63 ± 0.45 J/L; p = 0.50 and 23.5 ± 10.6 versus 22.6 ± 9.7 J/min; p = 0.70). There was no significant difference between the beginning and the end of the T-piece trial (1.57 ± 0.53 versus 1.72 ± 0.59 J/ L, p = 0.10). The work caused by the ETT amounted to 11.0 ± 3.9% of the total work of breathing. The supraglottic airway resistance was in the normal range and was significantly smaller than the endotracheal tube resistance (0.79 ± 0.4 versus 1.43 ± 0.31 cm H2O · s/L; p = 0.008, flow = 0.25 L/s). We conclude that a 2-h trial of spontaneous breathing through an endotracheal tube well mimics the work of breathing performed after extubation, in patients who pass a weaning trial and do not require reintubation.