Holy dead space, batman!
What is dead space? It's where inhalation and exhalation mingle within the same area (ie: in this case, the endotracheal tube) which may allow the patient to circulate unfiltered exhaled gas, aka CO2.
Dead space freaks me out! Imagine breathing through a long straw. Picture the unnecessary cardiovascular and respiratory stress you are putting on the body. Now, imagine you are breathing through a straw while you are sleeping. Nope, nope, nope. 🤯
Dead space can either be alveolar, anatomical or mechanical. Mechanical dead space can be found surrounding the connectors such as with adapters and alarms.
Even after I downsized this tube, it is still not the best fit for the pet, but I was concerned about cutting the cuff and I was confident that we could move forward safely. Vitals including (ET)CO2 were WNL during the 15 minute surgery.
When the tube was shortened, the SPO2 did rise from 93% to 100%. 🙌
It's important to size ETT's appropriately for all patients. If you are dealing with brachycephalic breeds or pediatric pets, consider retaining a separate stash of previously cut tubes to ensure the perfect fit for everyone.
Not everything is going to be the perfect size or fit (that's what she said), but being confident in your ability to adapt to challenges in anesthesia will make you a better patient advocate.
Disclaimer: I did not intubate this pet, but attended to the patient in surgery where I noticed and reduced the length of the tube ASAP. The LVT who intubated her was being pulled in many directions. Honestly, a simple oversight. Thankfully, being part of a functional #team
means having each others back.
Size 7 hand for scale.
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