Mapping the Epidemiologic Features of Endotracheal Tube Obstruction
Bibliographic record
Abstract
Background Endotracheal tube blockages (ETBs) are a common yet often overlooked cause of weaning failure, ventilator dyssynchrony, and hypoxia in the ICU, with limited studies on their prevalence, clinical factors, and outcomes. Research Question What are the incidence, risk factors, and associated clinical and ventilator factors of ETBs in ventilated patients in the ICU? Study Design and Methods We assessed 369 endotracheal tubes (ETTs) of mechanically ventilated patients after extubation. This prospective observational study was conducted at the tertiary cardiothoracic ICUs (CICUs) and medical ICUs (MICUs) of Narayana Health City, Bengaluru, India. Tubes were inspected visually and were cut at the point of maximum blockage, and cross-sectional images captured with a 12-megapixel camera were analyzed for ETB percentage using the SketchAndCalc algorithm. Results Of the 369 ETTs assessed, ETBs were categorized as showing low (0%-9%), moderate (10%-49%), and severe (> 50%) occlusion. In the CICU, severe ETBs was observed in < 2% of patients, compared with 4% of patients in the MICU, whereas moderate ETBs were present in 27.9% of patients in the CICU and 16.5% of patients in the MICU. On univariable analysis, suction type (β = 9.62 [95% CI, 5.27-13.98]; P < .01), peak pressure (P peak ; β = 1.73 [95% CI, 1.38-2.08]; P < .01), coagulopathy (β = 9.42 [95% CI, 4.22-14.62]; P < .01), and ICU type (β = 9.62 [95% CI, 5.28-13.96]; P < .01) were statistically significant. Multivariable regression analysis showed only P peak (β = 1.65 [95% CI, 1.28-2.02]; P < .01), coagulopathy (β = 8.02 [95% CI, 3.26-12.79]; P < .01) and larger number of days receiving invasive mechanical ventilation (β = 0.02 [95% CI, 0.01-0.03]; P < .01) to be significant factors associated with ETB percentage. Interpretation Moderate ETB was more prevalent in patients in the ICU, with significant factors including coagulopathy, closed suction practice, and mechanical ventilation duration. P peak alarms lacked clinical impact, despite statistical significance. Clinical Trial Registry Clinical Trial Registry-India; No.: CTRI/2023/10/058184; URL: www.ctri.nic.in
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".