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LETTERS TO EDITOR
Year : 2019  |  Volume : 63  |  Issue : 10  |  Page : 872-873  

Using endotracheal tube as an adaptor to provide incentive spirometry to tracheostomised patients


1 Department of Anesthesia, PGIMER, Chandigarh, India
2 Department of Anesthesia, GMC, Jammu, India

Date of Submission12-May-2019
Date of Decision22-May-2019
Date of Acceptance24-May-2019
Date of Web Publication10-Oct-2019

Correspondence Address:
Dr. Summit D Bloria
3245, Sector 15D, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_371_19

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How to cite this article:
Bloria SD, Bloria P, Luthra A, Kataria K. Using endotracheal tube as an adaptor to provide incentive spirometry to tracheostomised patients. Indian J Anaesth 2019;63:872-3

How to cite this URL:
Bloria SD, Bloria P, Luthra A, Kataria K. Using endotracheal tube as an adaptor to provide incentive spirometry to tracheostomised patients. Indian J Anaesth [serial online] 2019 [cited 2019 Oct 18];63:872-3. Available from: http://www.ijaweb.org/text.asp?2019/63/10/872/268718



Sir,

Incentive spirometry is an important tool for lung expansion and improvement in lung function. It expands collapsed alveoli and improves chest wall function.[1] However, the spirometers commercially available cannot be used by tracheostomised patients because the mouth end of the spirometer cannot be connected to the tracheostomy tube [Figure 1]. The patient end of commercial incentive spirometers have a 'rectangular' cross-section which cannot fit to the spherical end of a tracheostomy tube. We describe a modification of spirometer using an endotracheal tube and an angle piece which enables us to use spirometer in tracheostomised patients.
Figure 1: A commercially available incentive spirometer; 'rectangular' patient end does not fit to the 'spherical' endof a tracheostomy tube

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The plastic tubing from the main body of spirometer is removed and one end of a 8.5 polyvinyl chloride endotracheal tube is connected to the spirometer. The other end of the endotracheal tube is cut and connected to the angle piece of a breathing circuit [Figure 2]. In cases of suspected hypoxia without oxygen supplementation in a patient during incentive spirometry, the angle piece with a port for end-tidal CO2 sample line is connected to a oxygen tubing for oxygen supplementation.
Figure 2: Modification of incentive spirometer using an endotracheal tube and an angle piece. An oxygen tubing can be connected to etCO2port of angle piece if hypoxia is a concern

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Use of incentive spirometry in tracheostomised patients has not been properly explored. Malhotra et al. had suggested modifying spirometer with breathing circuit tubing and y-piece for use in tracheostomised patients.[2] However, many spirometers commercially available cannot be connected with breathing circuit tubings because of differing dimensions. Goldstein et al. had developed a customised incentive spirometer for tracheostomised patients and concluded that incentive spirometry in tracheostomised patients was well tolerated with no complications.[1] Our modification in tracheostomised patients of cervical spine trauma, head and neck surgery patients and motor neuron disease patients is feasible.

This modification has not been tried in patients with metallic tracheostomy tubes. Also, the effect of incentive spirometry on overall outcome of these patients needs to be determined.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Goldstein GH, Iloreta AM, Ojo B, Malkin BD. Incentive spirometry for the tracheostomy patient. Otolaryngol Head Neck Surg 2012;147:1065-8.  Back to cited text no. 1
    
2.
Malhotra N, Malhotra P, Verma D. Incentive spirometry in tracheostomized patients. J Anesth Clin Pharmacol 2007;23:77-8.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]



 

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