Effect of inspiratory flow waveform on work on endotracheal tubes: a model analysis.

OBJECTIVE

This model analysis aimed to predict the impact of different inspiratory flow wave-forms, i. e., constant, sinusoidal, and two linearly decreasing flows, on the resistive work (Wres) performed on endotracheal tubes.

DESIGN

Model analysis.

RESULTS

Model analysis predicts that: (i) minimal Wres is obtained with the constant flow; (ii) for any given tidal volume/inspiratory duration (V(T)/T(I), mean inspiratory flow), Wres increases with decreasing tube size; (iii) for any given inspiratory flow waveform, Wres increases with increasing V(T)/T(I), being lowest with constant flow.

CONCLUSIONS

These findings have major clinical implications: at any given ventilator setting, not only the size of the endotracheal tube but also the inspiratory flow waveform must be taken into account to interpret the values of Wres and hence of the total work of breathing.