MT19CDM022 Project Report With Signatures

Measurement of Flow and Pressure Drop across
Endotracheal Tube
Dissertation submitted to
Visvesvaraya National Institute of Technology, Nagpur
in partial fulfillment of the requirements for the award of
the degree
Master of Technology
in
Computer Aided Design & Manufacturing (CDM)
by
Pratik Vaidya (MT19CDM022)
under the guidance of

Dr. Rashmi Uddanwadikar Dr. Satish Deopujari
Department of Mechanical Engineering

Visvesvaraya National Institute of Technology
Nagpur 440 010 (India)
June 2021
© Visvesvaraya National Institute of Technology (VNIT) 2009
Department of Mechanical Engineering
Visvesvaraya National Institute of Technology, Nagpur
Declaration
I, Pratik M. Vaidya, hereby declare that this dissertation titled “Measurement of
Flow and Pressure Drop across Endotracheal Tube” is carried out by me in the
Department of Mechanical Engineering of Visvesvaraya National Institute of
Technology, Nagpur. The work is original and has not been submitted earlier whole or in
part for the award of any degree/diploma at this or any other Institution / University.
Signature
Pratik M. Vaidya
Date: 11-06-2021
Certificate
This to certify that the dissertation titled “Measurement of Flow and Pressure
Drop across Endotracheal Tube” is submitted by Pratik M. Vaidya in partial fulfillment
of the requirements for the award of the degree of Master of Technology in CAD-
CAM, VNIT Nagpur. The work is comprehensive, complete and fit for final evaluation.
Head, Department of Mechanical Engineering

VNIT, Nagpur
Date:
Visvesvaraya National Institute of Technology
Nagpur
Non-Plagiarism Certificate
Certified that M.Tech. Dissertation titled “Measurement of Flow and Pressure drop
across Endotracheal Tube” submitted by Vaidya Pratik Madhukarrao, Enrolment No
- MT19CDM022, ID No. 23618 has been checked for plagiarism using TURNITIN
software and the overlap is found within prescribed limits. A summary of the report is
given below;
Pratik Vaidya Dr. Rashmi Uddanwadikar

MT19CDM022 Asso. Prof. (Dept. of Mech. Engg.)
ID No. 23618 VNIT, Nagpur
Acknowledgement
First and foremost, I would like to express my heartfelt respect and

sincere gratitude towards my advisor and guide, Dr. Rashmi Uddanwadikar. I have
been blessed to have an advisor who provided me with all the necessary workplace
and equipment with the freedom to explore the field of engineering at the same time
the guidance to improve on my mistakes. Her mentoring and support helped me
overcome many challenges and finish this dissertation. I consider it my good fortune
to have an opportunity to work with such a wonderful personality.
Secondly, I would like to express my infinite gratitude to Dr. Satish

Deopujari, a well-known Pediatrician and enthusiastic professional known in his field as
ALGO-DOCTOR. This study is the brain child of one his explorations. I thank him for his
continued support and patience while advising me on this new unexplored territory of
medical terms and processes. I am also thankful to him for encouraging the use of
practical live demonstrations.
I would like to thank Dr. Bhutda and his entire team from Nelson Mother
and Child Hospital, Nagpur, for allowing me in their ICU premises and for guiding me with
the live demonstrations of the ventilators. I express my gratitude to Dr. V.R. Kalamkar,
Professor and Head of Department of Mechanical engineering and staff of Department
of Mechanical Engineering for extending all possible help in carrying out the
dissertation work directly or indirectly.
Pratik Vaidya
MT19CDM022
ABSTRACT
Endotracheal tube (ETT) is is mainly used as a connecting link between the external or
artificial breathing mechanism and the patient’s body. This is used to supply the gases
from ventilator to the natural breathing circuit. The ETTs proximal end is connected to
ventilator while the distal end is placed inside the body just before the brochies. The
ventilator is triggered using pressure or with using the volume flow rate.
The ETT have various parameters (geometrical, ventilator modes, biological factors etc.)
that can lead to drop in pressure and changes the flow pattern that is supplied through the
ventilator. Pressure, flow and tidal volume are measured at the end of ETT which is
connected to the ventilator i.e. to the end having 15 mm standard connector. The pressure
gradient as measured as the difference between supply end and receiving end of ETT can
be substantial. The actual amount of pressure required by the lungs thus needs to be
calculated to overcome the pressure gradient which affects resistance to flow of gas, to
avoid the accidents. This study also helps to calibrate the ventilators to adaptive mode
which will be more helpful.
The major problem arises with the ETTs used for infants and children. As the cross
section becomes too small, the resistance offered increases. There is also a problem of
choke up of tube or obstructions in tube which have severe effect on the patient.
This study emphasis on the measurement of flow and pressure drop across the ETTs for
infant and children, which will also help to conclude the early detection of obstruction
and choke up in the tube.
Keywords: Endotracheal tube, Obstruction, Flow Resistance
i
List of Figures
Ch. Figure Page

Title
No. No. No.
1 1.1 Airway Resistance 4
1.2 Artificial Airway and Patient Interface 5
1.3 Nomenclature of ETT Tube 6
1.4 Waveform for PIP, Plateau pressure and PEEP 8
1.5 Pressure waveform in IPPV 11
1.6 Pressure waveform in INPV 12
1.7 High Frequency Ventilation 12
3 3.1 Model of ETT of 2 mm ID 24
4 4.1 Obstruction at 25% Length in 2 mm ETT flow 31
4.2 Obstruction at 50% Length in 2 mm ETT flow 31
4.7 Model of Assembly to create artificial obstruction 34
4.8 Sliced parts using Repetior Host 35
4.9 TechB CU 3D Printer 35
4.1 Assembled 3D Printed Parts 36
4.11 Pressure countors for 2 mm tube with obstruction at 25% Length 38
5 5.1 Obstruction Vs Pressure for 2 mm ETT (Small Increament) 46
5.2 Obstruction Vs Pressure for 3 mm ETT (Small Increament) 46
5.3 Obstruction Vs Pressure for 2 mm ETT (Large Increament) 47
5.4 Obstruction Vs Pressure for 2 mm ETT (Large Increament) 48
ii
List of Tables
Ch. Table Page

Title
No. No. No.
1 1.1 Characteristics of Mechanical Breath type 6
4 4.1 Parameters of design of ETT of size 2 mm 28
4.2 Parameters of design of ETT of size 3 mm 29
4.3 Obstruction Values for 2 mm tube 29
4.4 Obstruction Values for 3 mm tube 30
4.5 Input Parameters for Analysis 37
5 5.1 Pressure values of 2 mm tube at obstruction at 25% length 42
5.2 Pressure values of 2 mm tube at obstruction at 50% length 43
iii
Index
Sr. No Content Page No.

Abstract
List of Figures
List of tables
1 Introduction 1
1.1 Mechanical Ventilation 1
1.2 Resistance 3
1.3 Artificial Airway resistance 4
1.4 Common Pressure Monitoring Parameters 8
1.5 Operating Principles 10
2 Literature Review & Aim and Objectives 13
A Literature Review 14
B Discussion 20
C Aim & Objectives 22
3 Methodology 23
4 Modeling & Analysis 27
A Modeling 28
B Analysis 37
5 Results & Conclusion 41
A Results 42
B Discussion 48
C Conclusion 49
D Future Scope 51
6 References 52
CHAPTER 1
INTRODUCTION
1
1. INTRODUCTION
1.1 Mechanical Ventilation
A therapy for patients with acute lung diseases or respiratory problems associated
with the different medical causes, given by mechanical means is termed as
Mechanical Ventilation. If performed appropriately, this therapy can temporarily and
artificially support or replace seriously damaged pulmonary functions, maintaining
normal or nearly normal ventilation and oxygenation. The mechanical ventilation buy
us more time and resources to treat those patients with medical illness and to
minimize severity of the problems of disease.
If performed appropriately, mechanical ventilation is a powerful and effective life-

saving tool. If performed inappropriately, however, mechanical ventilation may be
equally powerful and effective in harming the ventilated patient.
A set of specialized medical equipment is essential to perform this therapy. This

equipment is a ventilator system, which typically has six essential components:
(1) compressed gas (oxygen and air) supplies,
(2) An electrical power supply,
(3) A ventilator,
(4) A breathing circuit,
(5) An artificial airway, and
(6) The patient’s pulmonary system.
A ventilator, therefore, is just one part of a ventilator system.
Ventilation is used as almost primary therapy for the patients with problems
associated with the breathing, which may be a direct problem or is a result of other
injuries or diseases affecting on the respiratory system, they mainly include problems
associated with nose, lungs, respiratory airways, associated muscles and nerves, etc.
This problems can be treated or assisted effectively and completely by providing the
2
external means of respiration to the body in definite approach. This can help the
doctors to treat the patients and the disease, with which it is affected,
Mechanical ventilation is a cornerstone of intensive care in severely ill patients of all

age groups from newborns to adults. Mechanical Ventilation can be categorized in
many ways but primarily, they are categorized by the need of airways as
 Invasive Ventilation (Requires intubation)

 Non Invasive Ventilation (No need of intubation)
1.2. Resistance
Resistance of the fluid in airway of respiratory system is flow dependent. Whenever

a fluid flows through airway of respiratory system, some amount of resistance is
generated. It is usually expressed in millibars per litre per minute (mbar/ L/ min) or
centimetres of water per litre per minute (cmH2O/ L/ min).
The following factors determine the magnitude of resistance:
 Flow rate. The higher the flow rate, the greater the resistance, and vice versa.
If the flow rate drops to zero, resistance disappears.
 Physical properties of the tube, such as length, internal diameter, inner
surface, and curvature.
 Physical properties of the gas, such as density and viscosity. Heliox is a
mixture of helium and oxygen. It is sometimes used as a supply gas in
mechanical ventilation. The density of heliox is lower than that of air, which
is a mixture of nitrogen and oxygen. At the same flow rate, heliox generates
less resistance than air. This may be clinically beneficial in patients with
abnormally high airway resistance. This fact is the foundation of heliox
therapy.
 Figure 1.1 shows the concept of airway resistance for human respiration.
3
Fig 1.1: Airway Resistance [14]
As in the electrical analogy, the ohm’s law can be used to determine the equation
relating the pressure, flow of fluid and the resistance generated. Pressure gradient
across the respiratory airway per unit resistance generated can be termed as flow.
Flow = △P/ R
So, the resistance is bound to increase if the pressure difference across the airway
increases or if the flow rate decreases, and vice versa. To better understand this
concept, let’s take a look at some examples we see routinely in clinical practice:
 Intubation decreases the effective cross section of the airway, resulting in a

higher airway resistance. A larger pressure gradient is required to achieve the
same airway flow. This is particularly important for a ventilated patient who
is actively breathing.
 A partial occlusion of the gas passageway results in higher resistance to gas
flow. Typical examples include a kinked endotracheal tube (ETT), a bent or
compressed patient circuit tube, and a blocked air filter.
 An arbitrary change in length or inner diameter of a tube causes a
corresponding change in resistance.
 Asthma and bronchial spasm are well known clinical examples of excessive
airway resistance.
1.3. Artificial Airway resistance
A breathing circuit with an external airway mechanism termed as artificial airway

which is connected to the natural airway is shown in figure 1.2. A plastic tube, with
4
flexible enough to change its radius of curvature, which is used to connect the
patient’s natural breathing system to the artificial one is known as Endotracheal
Tube. One end of the endotracheal is connected to the ventilator which helps to
supply the air or fluid to lungs. Endotracheal tube or ETT can be termed as the
connecting link between the patient’s body and the artificial airway mechanism.
Invasive type of ventilation which requires the intubation of the tube in the tracheal
windpipe of the patient is done by endotracheal tube. The intubation will constantly
help the patient to get enough supply of gas and thus facilitates external ventilation.
The figure 1.2 shows basic circuit for artificial airway for patient.
Fig. 1.2: Artificial airway and patient interface [14]
Figure 1.3 shows the Endotracheal tube with the nomenclature of different parts. The
diameter of the ETT is less than the diameter of the patient’s trachea as it has to be
placed inside the trachea. As to create the more airway passage, the walls of the tube
are also kept to minimal thickness. Smaller airway passage results in more resistance
to flow. Thus it is of paramount importance to use ETT of correct size for the patient.
Poiseuille’s law states that resistance increases rapidly as diameter decreases, due to
the fourth power in the denominator.
Where, R = resistance, n = viscosity, l = length, and r = radius of the ETT.
5
Fig 1.3: Nomenclature of ETT tube
The resistance offered by ETT will need more pressure gradient between the alveoli
and atmospheric pressure to carry out the function of the breathing. This will be more
severe when the patient is supplied with artificial breathing by using the ventilator.
Various sources of the resistances and obstructions are to be known to treat patient
more effectively without having any accidents.
The major problem arises with the intubation of the infant and children as the size of
ETTs used for them are too small in size (ranging from 2.0 mm ID to 5mm ID). This
problem gets more severe if some other obstruction appears in the path of breathing
and offers more resistance thus increasing the patients’ work of breathing (WOB).
The ventilators are designed with various triggering mechanism according to

patients’ need and treatment as shown in the table below.
Table 1.1: Characteristics of mechanical breath types
6
The table shows that the main parameters for mechanical breath are pressure and flow.
Thus, this project mainly focuses on the resistance offered by the ETT tube across its
length and flow analysis across the ETT for various obstructions. The tube is to be
studied not only for the external obstructions but also for various geometrical parameters
of the tube.
The pressure drop across the ETT depends on
A. Geometric Characteristic
i. Diameter
ii. Length
iii. Shape
iv. Cross-sectional area
B. Ventilator Settings:-
i. Gas flow rate and its direction
ii. Gas composition
iii. Ventilation frequency
Also, the sources of various obstructions in the tube are:
A. Blockages by secretions
B. Partial Obstruction of the Endotracheal Tube by the Plastic Coating Sheared
from a stylet [11].
C. Sudden change in the cross section of the ETT due to external force.
Evaluating the pressure drop in neonatal and pediatric ETTs makes it possible to predict
the part played by the ETT in total airway resistance, as well as the additional WOB
imposed on the patient. Furthermore, this evaluation could be used to compensate for the
ETT pressure drop with new types of assisted ventilator modes.
7
1.4. Common pressure monitoring parameters
The sensors attached to the ventilator continuously detect and measures the pressure in
the breathing circuit termed as airway pressure. It is observed that the circuit pressure an
the respiratory airway pressure during the ventilation process as displayed in the monitor
of ventilator are almost identical. Thus they are mostly used as synonyms for each other.
The ventilator detects several pressure values as defined by the medical expertise, some
of the important pressure are
i. Peak inspiratory pressure (PIP)

ii. Plateau Pressure (P Plateau)
iii. PEEP
iv. Mean Airway Pressure (P Mean)
see Fig.1.4. These parameters are updated after every breath.
Fig 1.4: Waveforms for peak inspiratory pressure, plateau pressure, and positive end-
expiratory pressure (PEEP) [14]
Peak inspiratory pressure (PIP)
During a breath, the highest value of pressure detected the circuit or airway is termed as
Peak Inspiratory Pressure. It is also called peak pressure, positive inspiratory pressure,
maximum inspiratory pressure, maximum airway pressure, and peak circuit pressure.
Common abbreviations are PIP and P peak.
8
There are several components of the PIP. Some of them are
 PEEP;
 The maximum inspiratory pressure applied by the ventilator;
 Abnormal pressure overshoots or spikes, if present.
For different types of breaths such as pressure breaths and volume breaths, the
significance of PIP changes. It is described in the following pages.
i) PIP in a volume breath
The tidal volume to be supplied and the flow rate which has to give to patient or
inspiratory rate, are fixed in advance in the volume control breath. The external breathing
mechanism starts to pump the preset value of the volume with constant flow rate within
the set time. PIP varies depending on (a) Preset values of parameters, (b) Mechanism by
which the respiration is carried out, and (c) the patients response to the breathing activity
If any one of the above parameter changes, with other parameters constant, this will
affect the PIP value and corresponding changes have to be implemented.
ii) PIP in a pressure breath
The pressure at which the inspiration is to be taken place, also termed as inspiratory
pressure, is to be preset in the pressure breath. This inspiratory pressure s almost equals
to the difference in the amount of PIP and PEEP. The external breathing mechanism
supplies the fluid in the preset pressure to the patient. The volume to be supplied is
depended on (a) The preset inspiratory pressure, (b) The mechanism of the respiration,
(c) The patient’s response to the ventilation, and (d) the preset value of inspiration time
Any change in the four factors can cause a corresponding change in the resultant tidal
volume, provided that other factors remain unchanged.
Plateau pressure (Pplateau )
At the end of respiration, when the flow tends towards zero value, the pressure detected
is termed as Plateau Pressure. Plateau pressure is also called Ppause, end-inspiratory
pressure, P plat, P plateau, P I END, and P PL.
9
The lungs are in fully inflated stage while the plateau pressure is to be detected. Thus it
is of paramount importance to study this. It can be used to estimate the current static
respiratory compliance.
PEEP
The pressure which is detected at the end of the respiration cycle or after one complete
breath is termed as Positive End Expiratory Pressure (PEEP). It is also given in terms of
centimeters of water.
The PEEP can be obtained as two different values. One is the preset value on the setting
of the ventilator and another is the actual value which is measured at the end of the one
breath cycle. Ideally, both should be same or must be as close as possible.
Mean airway pressure (MAP)
The mean or average pressure which is supplied by the external circuit over one
complete breath is termed ass Mean Airway Pressure. It is expressed in centimeters of
water column or millibars. It is also called mean pressure, mean circuit pressure, P mean,
P MEAN, and mP aw.
1.5. Operating principles
There are various principles with which the mechanical ventilation can be applied. Some
of them are
1. Intermittent positive pressure ventilation (IPPV)
When the patients breathing airway system is integrated with the external
ventilation device such as ventilator, it is termed as Intermittent Positive Pressure
Ventilation. The breaths will be observed by supplying the pressure through external
mechanism in intermittent time period. The inspiration will occur when the supply
pressure from the external device will be higher than the alveolar pressure inside the
10
lungs. Similarly, the expiration will occur when the pressure at the alveoli will increase
moee than the pressure at the ventilator. Both of these phenomena are triggered with the
help of preset parameters on the ventilator. Fig. 1.5 shows a typical pressure waveform in
IPPV.
Fig 1.5: Pressure waveform in intermittent positive pressure ventilation (IPPV) [14]
2. Intermittent negative pressure ventilation (INPV)
When the patient’s natural airways are kept open to the atmosphere such that
the patient can exchange the breathing to atmosphere directly, it is termed as Intermittent
Negative Pressure Ventilation. In this type, patients mouth and nose are not covered up
such that the as the alveolar pressure changes with respect to the atmosphere pressure,
the fluid can move in or out of the breathing circuit.
When the alveolar pressure is reduced by applying a negative pressure on

the chest wall of patient’s body, the inspiration occurs. The outside air is forced to get
accumulated in the lungs. When the chest wall is released from the external pressure,
expiration occurs. The elastic expansion of the chest wall will increase the alveolar
pressure greater than the atmospheric pressure resulting in the release of the accumulated
gas from lungs to atmosphere. The phenomenon is opposite to that of the IPPV. Fig. 1.6
shows a typical pressure waveform in INPV.
11
Fig 1.6: Pressure waveform in intermittent negative pressure ventilation (INPV) [14]
3. High-frequency ventilation (HFV)
One of the most complex mechanisms of the ventilation is high- frequency

ventilation. The amount of breaths per minute or time is increased to higher level
than other types of ventilation in high frequency ventilation. The range can be 150
b/min or more than that.. the volume supplied is much more less than the other type
of ventilation. Figure 1.7 shows an example of high frequency ventilation pressure
wave.
Fig 1.7: High Frequency Ventilation [14]
12
CHAPTER 2
LITERATURE REVIEW &
AIM AND OBJECTIVES OF STUDY
13
2. LITERATURE REVIEW:
A. Literature
To better understand the problem associated with the obstruction in

Endotracheal tube and related flow and pressure measurements, referring to available
literature to be informed with the recent work done in this domain is a crucial
endeavor. This provides the opportunity and motivation to decide the project’s aim
and objective that is to be carried out during the course of research. This chapter
discusses the literature studied and in brief, the information they provided that helped
to carry out further improvement.
Roland Hentschel1, Julia Buntzel, Josef Guttmann and Stefan Schumann

carried out the study titled ‘Endotracheal tube resistance and inertance in a model
of mechanical ventilation of newborns and small infants -the impact of ventilator
settings on tracheal pressure’.[1] Two artificial lung models (glass bottles with
copper wool) with fixed compliance were mechanically ventilated with an infant
ventilator. Ventilation was performed via anatomically shaped small ETTs of five
different sizes (2.0, 2.5, 3.0, 3.5 and 4.0 mm inner diameter). Two piezoresistive
pressure transducers were mounted to measure the pressure drop across the ETT: the
first was placed behind the flow sensor and the ETT connector at the proximal
opening of the ETT to measure pressure at the proximal airway (Paw) and the second
transducer was positioned at the tip of the ETT immediately before the changeover
into the tracheal part of our lung model, reflecting the tracheal pressure (Ptrach).
The results from this experimentations shows that, the magnitude of

△PETT across a given ETT size increases with
(1) Increasing PIP, (2) decreasing inspiratory time (3) decreasing PEEP and (4)
increasing compliance of lungs.
Pierre Henri Jarreau, Bruno Louis, Giilles Dassieu, Luc Desfrere ,Perre
W. Blanchard, Guy Moritte, Daniel Isabey & Alain Harf performed the ‘Estimation
of inspiratory pressure drop in neonatal and pediatric endotracheal tubes’[2].
14
The pressure-flow relationship was studied for the ranges of flow rates used in
clinical practice, as well as for higher flow rates, so as not to exclude any clinical
situation. The range of flow studied therefore included and extended beyond the
entire clinical range for each ETT. Pressure drop and flow were measured by using
two different setups.
The results from this study concluded that the pressure drop due to the
ETT may be evaluated by general formulas that take account of flow, ETT geometry,
and gas properties. When the ETT pressure drop is known, ETT resistance can be
separated from total resistance, and the ETT WOB can easily be calculated from the
measurement of the inspiratory flow.
Computational Fluid Dynamics Modeling of Respiratory Airflow in

Tracheobronchial Airways of Infant, Child and Adult [3] is a project carried by
E. G. Tsega. The objective of this study was to investigate quantitatively the
inspiratory and expiratory airflow characteristics (velocity, pressure, and wall shear
stress) in tracheobronchial airways of infant, child, and adult using CFD modeling.
The result shows the various CFD models for Velocity Distribution,
Pressure Distribution and Wall shear stress. It concluded that the airflow
characteristics (velocity, pressure, and wall shear stress) decrease with age during
inspiration and expiration; and there is variation of airflow pattern among the three
age groups and between the two phases of respiration.
C.F. Doershuk & L.W. Matthews carried out the study titled ‘Airway
Resistance and Lung Volume in the Newborn Infant’[4]. This study conducted on
the group of infants gives us the parameters as follows.
For the input parameters as the mean respiratory rate of 36 of the infants
was 67±17 breaths per minute, the mean tidal volume of 25±4 ml resulted in a mean
minute volume of 1721±399 ml, the tidal volume per unit body weight was 8.4±1.8
ml/kg, and the mean minute volume per unit body weight was 588±115 ml/kg, the
15
resulted mean value for airway resistance was 19.2 cm H,O/l/s. Airway resistance
was determined in these newborns when the airflow rate was 0.1 l/s, a value
considerably less than that of older subjects who have been studied.
The project titled ‘Pressure drop across neonatal endotracheal tubes

during high-frequency ventilation’[5] conducted by S. Schumann, M. Krappitz, C.
Stahl, K. Möller, R. Hentschel and J. Guttmann aims at the laboratory study to
evaluate the pressure drop across the ETT during HFV and to investigate whether
tracheal pressure can be calculated from airway pressure using conventional
methods.
The study concluded that decisions for setting parameters of HFV must
be made from the view of tracheal pressure. For an adequate noninvasive monitoring
of tracheal pressure during HFV, new methods for calculation of the pressure drop
across the ETT appear crucial. An increased pressure drop during HFV caused by the
ETT must be considered to be dependent on the size of the ETT, the ventilation
frequency and the flow rate, the latter implicating a dependency on the ventilator’s
performance in flow delivery.
P. M. Bolder, T. E. J. Healy, A. R. Bolder, P. c. w. Beatty and B. Kay

performed study titled ‘The Extra Work of Breathing Through Adult
Endotracheal Tubes’, [6] which aim to compare endotracheal tubes of different
sizes and to examine the suitability of using the extra work involved in breathing
through them for this comparison. A SinuSoidal flow generator aas connected to
adult endotracheal tubes of sizes 5-20 and was used to simulate human ventilation.
Measurement of the changes in pressure and flow allowed calculation of the work
imposed on breathing by endotracheal tube.
Results shows that work increases whenever endotracheal tube diameter

decreases, ventilatory rate increases or tidal volume increases. The difference in the
magnitude of extra work incurred by a change in tube size was greatest when small
16
tubes were compared. A 1-mm decrease in tube size results in an increase in work of
34-154%, depending on the ventilator rate and tidal volume.
G. Conti, R.A. De Blasi, A. Lappa, A. Ferretti, M. Antonelli, M. Buff,

A. Gasparetto completed the study titled ‘Evaluation of respiratory system
resistance in mechanically ventilated patients: the role of the endotracheal tube’
[7] with objective To investigate the role played by the endotracheal tube (ETT) in
the correct evaluation of respiratory system mechanics with the end inflation
occlusion method during constant flow controlled mechanical ventilation.
The conclusion drawn is, When precise measurements of ohmic

resistances are required in mechanically ventilated patients, the measurements must
be obtained from airways pressure data obtained at tracheal level. The "in vivo"
positioning of ETT significantly increases the airflow resistance of the ETT.
Behzad Maghsoodi, Golnar Sabetian, Aram Azimi, Nader Tanideh and

Alireza Mehdizade carried out the study titled ‘Sound level analysis in
endotracheal tube obstruction in spontaneous breathing and mechanical
ventilation—an animal model study’ [8] in which Artificial internal obstructions
were created in three different sizes and three different locations by stitching pieces
of smaller tubes in ETTs with internal diameter of 8 mm. This study is aimed to
assess changes in respiratory sound signals after creation of different types of tubal
obstruction in an animal model experiment.
Data analysis revealed that sound intensity level decreased significantly

when the degree of obstruction increased. In addition, this change in sound level was
not related to the location of obstruction. The decrease in sound intensity changes can
be used to detect ETT obstruction.
‘Resistance of neonatal endotracheal tubes: a comparison of four

commercially available types’ [9] carried out by J Spaeth, D Steinmann, J
Guttmann and S Schumann, The aim of this study was to compare the resistive
17
pressure drop of four commercially available neonatal ETTs with internal diameter
(ID) of 2.0 mm. The pressure–flow relationship of neonatal ETTs (internal diameter
2.0 mm) of four different manufacturers was determined in a physical model
consisting of a tube connector, an anatomically curved ETT and an artifi cial trachea.
The model was ventilated.
The pressure drop profiles of all ETTs were nonlinearly flow dependent.
The expiratory pressure drop (Pexp) slightly exceeded the inspiratory one (Pinsp),
concluded that neonatal intubation with a Cole’s tube can clearly reduce the resistive
load due to the endotracheal tube and thus potentially prevent additionally work of
breathing.
Christian Straus, Bruno Louis, Daniel Isabey, François Lemaire, Alain

Harf and Laurent Brochard completed the study titled ‘Contribution of the
Endotracheal Tube and the Upper Airway to Breathing Workload’ [10], aim
was to compare the work of breathing of 14 successfully extubated patients at the end
of a 2-h trial and after extubation 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. Recordings were performed at the beginning of
the T-piece trial for subsequent computation of patient inspiratory work of breathing.
During the T-piece trial, the work induced by the endotracheal tube was
around 10% of the total work performed by the patient. Furthermore, the work of
breathing did not significantly change between the beginning and the end of a 2-h T-
piece trial.
A case report by Anirudha Das, Shwetha Chagalamarri, and Kim

Saridakis titled ‘Partial Obstruction of the Endotracheal Tube by the Plastic
Coating Sheared from a Stylet’ [11] concluded that the case demonstrates that
application of excessive force while taking the stylet out after intubation could lead
to shearing and lodging of the plastic sheath in the lumen of the ETT.Though this is a
18
rare occurrence, this mechanism of mechanical obstruction of the ETT should be kept
in mind while taking care of intubated infants in the NICU.
J. Guttmann, L. Eberhard, C. Haberthür, G. Mols, V. Kessler, M.

Lichtwarck-Aschoff & K. Geiger worked on study titled ‘Detection of endotracheal
tube obstruction by analysis of the expiratory flow signal’ [12]. The objective of
this study was to propose a computer-assisted method for detecting ETT obstruction
during controlled mechanical ventilation. The method only requires measurement of
the expiratory flow. They carried out study on 3 patients with partial ETT or
bronchial obstructions and 7 ARDS patients.
The study concluded that an ETT obstruction can be reliably

distinguished from an increase in pure airway resistance by a characteristic pattern
change in the time-constant of passive expiration as a function of expired volume
function, which can be detected easily even by an automated pattern recognition
system
Habib Md. Reazaul Karim and Prithwis Bhattacharyya completed their

study titled ‘A Retrospective Study of Endotracheal or Trache ostomy Tube
Blockage and Their Impact on the Patients in an Intensive Care Unit’ [13]. In an
epidemiological study by Kapadia et al. has found 26 airway accidents in 5043
endotracheally intubated patients during 8446 patient ET days. Observation also
showed that many of the tubes were lined internally by encrusted secretions.
Inadequate humidification of dry gas may be attributable to this which is also
regarded as a modifiable risk factor
19
B. Discussion:
This literature review provided a great help in understanding the basic problems
regarding the obstruction in Endotracheal tube, its causes, necessary ventilator
modes, case studies regarding the detection of the obstruction in ETT. The key
outcomes of the literature review are
Although fatality from tube blockage is rare, timely measures to

tackle such incidents may avert such preventable deaths. The literature shows the
sample analysis on 2517 patients out of which 975 i.e. 38.73% were intubated
and ventilated. The study shows the fatality is avoidable with proper data
readings.
Several causes are reported as the reason for the obstruction in the
ET tube. They can be present as secretions of patients, external compression,
sheared plastic stylet, etc. This causes can listed out as external factors,
geometrical factors or internal factors. By focusing on various approaches to the
different obstacle media, the study can be performed in more simple form.
The obstruction and resistance to airways can be studied with

different approaches. This can be done by mathematical model approach,
simulation based approach, computational fluid dynamic modeling etc. One
model complies with another with reference to their outcomes and results
concluded. This also shows that there are many more opportunities in this field
for study.
Some studies are also done on animals with different approach i.e.
Sound level Analysis. This is also helpful for humans patients. This study shows
the importance of this project is wider in areas. The sound level analysis part is
not done for the humans. This opens a way for scope or methodology to carry
out project.
20
Some of the studies are also helpful to confirm the parameters used
for the patients during ventilation. We can use those values for our analysis.
There are several standards given by pediatricians in which values are given in
the form of ranges. So for exact inputs, we can refer to literatures available.
The resistance is related to various parameters including the ETTs

geometrical one. But as the ETTs are standardized under the ISO 5361: 2016, the
geometrical parameters are taken as constant for specific tube size. The
standardization of tube will help us to further lower the cases available for the
study.
The two basic parameters for ventilator settings are flow and
pressure. Thus number of modes can be studied by varying these two parameters.
Majority of the literature is given on this parameters.
21
C. AIM AND OBJECTIVES
After reviewing the literature, it was evident that early detection of

obstruction in an Endotracheal tube is still a field of research blooming with
possibility of experimentation and gathering of data related to parameters set up in
the ventilator for any specific patient. Moreover, it is necessary to quantify this
parameters to detect the obstruction. Thus, it was decided to conduct the research
work with a view of fulfilling the aim
 Measurement of Flow and Pressure drop across the endotracheal tube for infants
& children for early detection of obstruction.
In order to achieve the aim defined for the project, following mentioned objectives
were set on focus.
 Objective 1 :
To determine in-vitro the pressure–flow characteristics of ETTs with respect to their

properties
 Objective 2 :
To assess the significance of △P ETT as an additional impact on ventilator setting with

varying obstacle area in ETT.
 Objective 3 :
To compare the In-Vitro model values with the CFD calculation values of △P ETT .
22
CHAPTER 3
METHODOLOGY
23
3. METHODOLOGY
This study is planned to be carried out by the two paths i.e. by
modeling the ETT tube with the help of modeling software (CATIA V5R20) and
importing it for CFD analysis in analysis software package (ANSYS Workbench
2020 R2, Module: Fluent) and then experimenting with the actual ETT in lab
with the help of pressure and flow sensors. The data values for both will be taken,
compiled and studied to determine the early detection of obstruction in ETT tube
for any obstruction while treating the infants and children.
For our study, the main importance is given to the tube and other
components of the ETT are neglected at the time of modeling. This will have no
effect on the results as the tube flow will not get disturbed or affected by other
components of ETT as shown in the fig 3.1. Modeling is done with the tube and
15 mm standard connector only.
Fig 3.1: Model of Endotracheal Tube of 2 mm ID
We started with the Modeling of ETT and CFD analysis for the tube
size corresponding to infants. The tubes we used for the analysis are of size 2 mm
and 3 mm. The tubes is modeled as normal one (i.e. without any defect) and then
with some amount obstruction which will reduce the cross section of tube at
specific length. The flow pattern and the countors around the obstructions will be
of paramount importance to us. An example of modeled tube is shown in fig 4.1
24
Another main aspect of the modeling is the design for the obstruction
in the tube. We have defined the obstructions over a length of 5 to 10 mm with
reduction in the cross sectional area. The reduction in the area will be defined in
percentage reduction in area with specified values (i.e. 5% reduction, 10%
reduction etc.). The position of the obstacle is assumed at three places, one at a
time for the analysis purpose, as at 1/4th length, mid length and at 3/4th length.
This will again simplify our model to calculate the results.
Accordingly, we have considered 7 different sizes of obstructions at

three different lengths for a single tube, which resulted into 21 different models
for each tube. We analyzed these tubes for flow and pressure inputs taken from
the literatures. Considering the analysis, the same inputs are followed for every
model for easy comparison.
We have focused our aim towards early detection of the obstruction.

Thus the parameters we have used from the literature is taken on the smaller
values in the available ranges. The detection is hard when the flow is less and the
frequency is high so we have also limited our analysis to the least values given
the literature.
Another aspect of this project is the study of the pressure waves

displayed by the ventilator and changes in them with the presence of the
obstruction in the Endotracheal tube. We tried to create the artificial obstruction
in the ETT for the purpose of the study. The requirement of this artificial
obstruction should be such that it should be of measured value or size and is to be
present there rigidly during the test. Thus we created a fixture model such that it
will compress the tube from external force. This type of obstruction is verified in
the literature.
The fixture model is then 3D printed with the help of 3D printer. As

explained later, we require the different size of base plate for different size of
tubes, we have gone for the 3D printing as a cheap, time efficient and precise
method to develop the fixture.
25
Compilation of the data obtained from the analysis is to be done and
arranged to give a picture easy to detect the obstruction. This will get cleared in
the subsequent chapters.
26
Chapter 4
Modeling & Analysis
27
4. MODELING AND ANALYSIS
A. Modeling
As previously discussed, this study focuses on the Endotracheal
tubes for the infants and children, we here considered the modeling of two sizes
of ETT i.e. 2 mm and 3 mm. Both the tubes are modeled with the normal flow
without obstruction and then with obstruction of different sizes. The size of
obstruction is taken as reduction in the flow area of the tube. The different sizes
of obstructions are listed below for analysis of flow characteristics.
i. Normal tube (No Obstruction)
ii. Tube with 5% obstruction
iii. Tube with 10% obstruction
iv. Tube with 15% obstruction
v. Tube with 20% obstruction
vi. Tube with 25% obstruction
vii. Tube with 50% obstruction
viii. Tube with 75% obstruction
This are designed with the data given in the following tables. These
parameters are taken with reference to the ISO standard for Endotracheal tubes.
Table 4.1 shows the parameters for 2 mm ID ETT.
Table 4.1: Parameters of Design of ETT of size 2 mm
Sr. No. Parameter Value Unit

1 Internal Diameter 2 mm
2 External Diameter 2.7 mm
3 Radius of Curvature 140 mm
4 Length of tube 140 mm
5 Connector ID 12 mm
6 Connector OD 15 mm
7 Length of Obstruction (if present) 5-10 mm
28
The Endotracheal tube with ID 3 mm also has similar parameters for design with
minute changes in values. It is given in the table 4.2
Table 4.2: Parameters of Design of ETT of size 3 mm

1 Internal Diameter 3.0 mm
2 External Diameter 4.0 mm
3 Radius of Curvature 140 mm
4 Length of tube 165 mm
5 Connector ID 12 mm
6 Connector OD 15 mm
7 Length of Obstruction (if present) 5-10 mm
As obstructions are also defined as of the reduction in cross section

area, following details will give an idea for the obstruction size. This reduction in
the size of area for flow is taken constant from all the sides. Table 4.3 shows the
obstruction areas of 2 mm size ETT.
Table 4.3: Obstruction Values for 2 mm tube
Diameter of ETT at the

Area
obstruction
Case 1 Normal Tube 2.000 mm 3.1415 mm2
Case 2 Tube with 5% Obstruction 1.9492 mm 2.9844 mm2
29
Similar to the above table, the same is applied to the 3 mm ID ETT
which helps to give the idea of obstruction. Table 4.4 shows the details about 3
mm ETT obstruction.
Table 4.4: Obstruction Values for 3 mm tube
Diameter of ETT at the

Area
obstruction
Case 1 Normal Tube 3 mm 7.0685 mm2
Case 2 Tube with 5% Obstruction 2.9240mm 6.7151 mm2
Case 4 Tube with 15% Obstruction 2.7658 mm 6.0082mm2
The models are shown in following figure.

We have analyzed the models considering the flow of fluid through
the ETT. As shown in the fig 4.1, seven different cases for 2 mm ETT with
obstructions at 25% of its length as listed in the previous table 4.3, are modeled.
Following it, the figure 4.2 and figure 4.3 shows the models of ETT
of size 2 mm with obstructions at 50% and 75% of its length respectively.
30
Fig 4.1: Obstruction at 25% length in 2 mm Endotracheal tube flow
31
The figure 4.4, fig 4.5 and fig 4.6 and shows the models of 3 mm ETT of ID 3
mm with obstruction at 25%, 50% and 75% of length respectively.
32
33
Another aspect of this project was to study the pressure waves of the
ventilators for different obstruction. To create this artificial obstruction, we have
modeled an assembly which can be 3D printed and used for the practical
experimentation. We modeled those parts on CATIA V5. The figure 4.7 shows
the assembly for the artificial obstruction.
Fig 4.7: Model of Assembly to create the Artificial Obstruction
The assembly consists of the 3 main parts that has to be 3D printed.

These are Main Body, Base plate and Pusher that to be connected to bolt. The
pusher and the base plate is to be printed with different dimensions to fit the
different sizes of Endotracheal tube.
These modeled parts are then imported in the Repetier-Host, a

software used for the slicing and to create the G-Codes that will be the input for
the 3d printing device. The sliced images of different components are shown
below in fig 4.8.
34
Fig 4.8: Sliced parts using Repetier-Host
After creating the G-Codes, these are fed to the 3D printer.
Fig 4.9: TechB CU 3D Printer
The printer we have used is the TechB-CU 3D printer as shown in fig 4.9 in
Solid Mechanics Laboratory, VNIT, Nagpur. The 3D printed parts after the
assembly is shown in figure 4.10.
35
Fig 4.10: Assembled 3D printed Parts
After compressing the tube between Base Plate and the Pusher, the diameter of
the compressed tube is measured with the help of a Vernier Caliper. This
diameter can be then calculated in the terms of the reduction in flow area of the
tube which will act as an artificial obstruction.
36
B. ANALYSIS
The flow through Endotracheal tube models designed in the CATIA V5 R20 are
imported in the ANSYS Workbench 2020 R2 with ‘―.igs’ extension. The
analysis is done in the Fluent module. The input parameters are defined from
available literature. They are enlisted in the following table 5.5.
Table 4.5: Input Parameters for Analysis

1 PIP 20 cm of H2O
2 Tidal Volume 25 ml/kg
3 PEEP 5 cm of H2O
4 Inspiration Velocity 2.22 m/sec
5 Alveolar Pressure at Inspiration -5 cm of H2O
The following assumptions are made for the analysis.

i. The wall surface is taken as smooth boundary.
ii. The fluid is taken as air at 250 C with all parameters corresponding to that
temperature.
iii. The flow across the whole pipe is taken as laminar.
The results are obtained as the velocity streamlines and pressure countors. These
are shown in following figures.
Figure 4.11, figure 4.12 and figure 4.13 shows the pressure countors of 2 mm ID
ETT fluid flow with obstruction at 25%, 50% and 75% of length respectively,
which can be seen with different colour codes.
Figure 4.14, figure 4.15 and figure 4.16 shows the pressure countors of 3 mm ID
ETT fluid flow with obstructions at 25%, 50% and 75% of length respectively.
37
Fig 4.11: Pressure countors for 2 mm tube with obstruction at 25% length
38
39
40
CHAPTER 5
RESULTS & CONCLUSION
41
5. Results and Discussion
A. Results
As we study the various the models and their simulation in ANSYS Workbench
2020 R2, various results are derived. One of the important results obtained is the
pressure contours of models with different percentages of obstruction at different
lengths. These countors show the variations in the pressure along the flow across
the Endotracheal tube.
In the actual ventilator, the pressure flow characteristics are measured only at the
tip of connector of ETT i.e. the parameters are studied at the proximal end of the
tube considering the ventilator. So for a clear image, we have taken the pressure
readings at the tip of endotracheal tube where the connector gets connected.
These variations in values for different size of tubes with different size of
obstructions are given in the following table.
The table 5.1 shows the pressure values in the ETT 2 mm ID with presence of
obstacle at 25% length at the tip of the connector of ETT and the maximum and
minimum pressure in the flow area of the tube
Table 5.1: Pressure values of 2 mm tube at obstruction at 25% Length
% Reduction in flow Pressure at tip of

Min Pressure Max Pressure
area/Obstruction size connector
5 5509.79 334.533 10908.1
10 5517.73 295.157 10819.7
15 5662.09 287.265 10967.5
20 5897.78 307.323 11184.8
25 6048.22 -824.34 11342.3
50 9048.7 -11142.5 14336
75 34290.8 -70188.1 39634.2
42
obstruction at 50% length at the tip of the connector of ETT and the maximum
and minimum pressure in the flow area of the tube
% Reduction in flow Pressure at tip of Min Max

area/Obstruction size connector Pressure Pressure
5 5450.52 279.654 10750.8
10 5502.43 328.356 10820
15 5629.87 304.092 10961.4
20 5860.81 -471.14 11196
25 6038.92 -1840.95 11353.9
50 8942.32 -12232.4 14269.4
75 32622.7 -67599.2 38028.3

5 5465.67 324.916 10771.6
10 5531.22 -149.641 10449.5
15 5668.05 823.067 10978.9
20 5853.25 -1600.55 11150.7
25 6105.22 -3064.28 11405.6
50 9490.84 -14943.4 14785
75 31575.8 -63292.2 36989.8
43

5 1519.86 376.532 2557.37
10 1526.31 384.114 2562.76
15 1551.47 375.606 2589.27
20 1590.95 380.928 2627.47
25 1635.01 314.989 2672.75
50 2273.76 -1644.04 3309.3
75 6853.73 -13681.3 7882.68

5 1533.11 377.274 2572.38
10 1547.13 377.868 2584.97
15 1568.79 378.897 2605.43
20 1609.26 283.226 2638.12
25 1642.4 -30.551 2676.65
50 2199.34 -1893.35 3239.31
75 7300.53 -12502 8334.41
44

5 1563.31 379.374 2600.35
10 1567.5 292.21 2602.28
15 1588.71 201.885 2633.53
20 1637.21 -2.50162 2675.75
25 1685.55 -253.558 2720.34
50 2293.77 -2767.41 3332.84
75 6937.22 -12802.5 7975.1
The above tables show some interesting readings about the increase in pressure for the
rise in obstruction size. This can be analyzed more clearly on graph plots.
Plotting the obstruction size vs. pressure graph, we can get a clear view.
Figure 5.1 shows the obstruction vs pressure at tip of the connector for 2 mm ID
ETT visualizing the data from previous table 5.1, table 5.2 and table 5.3.
45
Obstruction vs. Pressure
6200
6000
Pressure (Pascal) 5800
5600
25% Length
5400
50% Length
5200 75% Length
5000
4800
0 5 10 15 20 25
Reduction in flow area (Obstruction Size)
Fig 5.1: Obstruction vs. Pressure for 2 mm ETT (Small Increment)
Figure 5.2 shows the obstruction vs pressure at tip of the connector for 3 mm ID
ETT visualizing the data from previous table 5.4, table 5.5 and table 5.6.

1750
1700
1650
Pressure (Pa)
1600
1550 25% Length
1500 50% Length

75% Length
1450
1400
1350
0 5 10 15 20 25
Fig 5.2: Obstruction vs. Pressure for 3 mm ETT (Small Increment)
46
Also, for concluding the discussions, we go for more plots with big range to
analyze the pressure behavior. Thus we plotted the Obstruction vs. pressure graph
separately for higher value of obstruction.
So, figure 5.3 shows the Obstruction vs. Pressure graph for higher ranges of
obstruction in 2 mm ID ETT.

40000
35000
30000
Pressure (Pa)
25000
20000 25% Length
15000 50% Length

75% Length
10000
5000
0
0 25 50 75
Fig 5.3: Obstruction vs. Pressure for 2 mm ETT (Large Increment)
Figure 5.4 shows the Obstruction vs. Pressure graph for higher ranges of
obstruction in 3 mm ID ETT.
47
8000
7000
Pressure (Pa) 6000
5000
4000 25% Length
3000 50% Length

75% Length
2000
1000
0
0 25 50 75
Fig 5.4: Obstruction vs. Pressure for 3 mm ETT (Large Increment)
B. Discussion
1. As we can observe from the plots, the plots for the 2 mm ETT and 3 mm ETT
seems almost similar to each other.
2. The slope of the all plots is increasing steadily with increase in the size in
obstruction (i.e. decrease in the flow area of the tube)
3. The different lines which represent the presence of obstacle in different length
seem to overlap each other. This also can be seen for both the size of tubes.
4. The slope of the curves in fig seems to increase with increase in the obstacle size
i.e. the slope of curve between 25 to 50% obstruction size is more than 0 to 25%
and so on.
48
C. Conclusion
In the process of working on this project, the Endotracheal tube and its
parameters was explored in details and the problems associated with it are thoroughly
studied. Depending on the application area of tube, various ventilator settings are studied
to determine the input parameters for analysis. To enhance the scope of the study, the
cases are at which the detection of the problem is harder in the current case to give more
deliverable output from this project. Apart from this, the cases are repeated for two
different sizes of tubes to conform the results are compiling with each other.
The tube sizes of 2 mm and 3 mm are chosen as the focus for this project.
The minimum flow input was given for analysis as to detect the changes in the pressure
values which will eventually help to detect the detection of presence of obstruction and
its severity in terms of its size.
Another aspect of this study to perform trials on ventilator with the help of
test lungs and observe the changes in the parameters on display of ventilator as we use
different size of artificial obstruction in the Endotracheal tube. The assembly for the
creation of artificial obstruction was 3D printed. But due to Covid pandemic and
followed lockdowns, the approach could not be completed.
Following conclusions were drawn through the research conducted:
1. The pressure values at the distal end of the connector increases with the increase
in obstruction size. The reduction in flow area as small as 5% can give
approximately 50 to 150 Pascal rise than normal tube flow.
2. This rise in pressure can be calibrated in the pressure waves to early detect the
presence of obstruction in the Endotracheal tube.
3. The almost overlapping curves in the graphs show that the rise in pressure is the
sole effect of size of obstruction rather than the length at which it is present.
49
4. Thus to detect the obstruction in the Endotracheal tube, only one sensor can help
which should be placed at the proximal end of tube rather than two different
sensors at proximal as well as distal end of the tube.
5. The pressure ranges for 2 mm tube are far greater than the pressure ranges in 3
mm tube. This justifies and also validates the Poiseuille’s law.
6. The slope of the curves in fig seems to increase with increase in the obstacle size
i.e. the slope of curve between 25 to 50% obstruction sizes is more than 0 to 25%
and so on. This explains that there is Non-Linear relationship between them. This
is also confirmed by the reference studies.
50
D. Future Scope
The researches and scientific works are always a work in progress, and
further experimentations have a vast scope for incorporating superior method and
approaches for optimization and refinement of data. However, time, resources and
sometimes a pandemic constraint restrains the pursuit of such ambitious goals.
This project would benefit for further experimentation and can be extended
in following ways:
 By considering the every standardized sizes of the Endotracheal tube, a data sheet
can be generated for the each size of ETT which will more easily shows the
changes in parameters for obstructions.
 The analysis can be done for both lower and higher value range which will be a
wider applicable deliverable.
 The validation of results by performing actual experimentation on ventilator with

external artificial obstructions can be done.
 This project is done only for pressure triggering mode of the ventilator. Similar
study can be done for other triggering mechanisms and their outputs will be of
paramount importance in this field.
 By creating artificial secretions rather than external compression of the tube as

the reason for the obstruction creation, a separate analysis can be completed and
the results can be verified with different approach.
 The curvature of the tube also varies with patient to patient. By considering the
curvature of the tube for different range, there is scope for validation of the
results obtained.
51
CHAPTER 6
REFERENCES
52
6. References
1. Roland Hentschel1, Julia Buntzel, Josef Guttmann and Stefan Schumann
(2011) Endotracheal tube resistance and inertance in a model of mechanical
ventilation of newborns and small infants—the impact of ventilator settings
on tracheal pressure 10.1088/0967-3334/32/9/007
2. Pierre Henri Jarreau, Bruno Louis, GIilles Dassieu, Luc Desfrere ,Perre W.
Blanchard, Guy Moritte, Daniel Isabey & Alain Harf (2017) Estimation of
inspiratory pressure drop in neonatal and pediatric endotracheal tubes
10.220.33.4
3. E.G.Tsega,2018, Computational Fluid Dynamics Modeling of Respiratory

Airflow in Tracheobronchial Airways of Infant, Child and Adult,
Computational and Mathematical Methods in Medicine Volume 2018, Article
ID 9603451, 9 pages, doi.org/10.1155/2018/9603451.
4. C.F. Doershuk & L.W. Matthews, 1969, Airway Resistance and Lung
Volume in the Newborn Infant, Airway resistance lung conductance newborn
infant, Pediat. Res. 3: 128-134 (1969).
5. S Schumann, M Krappitz, C Stahl, K Möller, R Hentschel & J Guttmann

(2006), Pressure drop across neonatal endotracheal tubes during high-
frequency ventilation, Critical Care 2006, 10(Suppl 1), P24
doi:10.1186/cc4371
6. P. M. Bolder, T. E. J. Healy , A. R. Bolder, P. c. w. Beatty, and B. Kay

(1986),The Extra Work of Breathing Through Adult Endotracheal Tubes,
Anesth Analg, 1986:65:853-9
53
7. G. Conti, R.A. De Blasi, A. Lappa, A. Ferretti, M. Antonelli, M. Buff, A.
Gasparetto (1993), Evaluation of respiratory system resistance in
mechanically ventilated patients: the role of the endotracheal tube, Intensive
Care Med (1994) 20:421-424
8. Behzad Maghsoodi, Golnar Sabetian, Aram Azimi, Nader Tanideh, Alireza

Mehdizade, (2016), Sound level analysis in endotracheal tube obstruction in
spontaneous breathing and mechanical ventilation—an animal model study, J
Clin Monit Comput (2017) 31:1235–1240 DOI 10.1007/s10877-016-9973-y
9. J Spaeth, D Steinmann, J Guttmann, S Schumann, (2013), Resistance of

neonatal endotracheal tubes: a comparison of four commercially available
types, Critical Care 2013, 17(Suppl 2):P160 doi:10.1186/cc12098
10. Christian Straus, Bruno Louis, Daniel Isabey, François Lemaire, Alain Harf
and Laurent Brochard, (1998), Contribution of the Endotracheal Tube and the
Upper Airway to Breathing Workload, AM J RESPIR CRIT CARE MED
1998;157:23–30.
11. Anirudha Das, Shwetha Chagalamarri, and Kim Saridakis,(2015), Partial

Obstruction of the Endotracheal Tube by the Plastic Coating Sheared from a
Stylet, Hindawi Publishing Corporation Case Reports in Pediatrics Volume
2016, Article ID 4373207, doi: 10.1155/2016/4373207
12. J. Guttmann, L. Eberhard, C. Haberthür, G. Mols, V. Kessler, M. Lichtwarck-

Aschoff, K. Geiger, (1998), Detection of endotracheal tube obstruction by
analysis of the expiratory flow signal, Grant No. 3200-39382.93, Intensive
Care Med (1998) 24: 1163-1172,
13. Habib Md. Reazaul Karim, Yunus, Prithwis Bhattacharyya (2020), A

Retrospective Study of Endotracheal or Tracheostomy Tube Blockage and
Their Impact on the Patients in an Intensive Care Unit, Journal of Mahatma
Gandhi Institute of Medical Sciences, DOI: 10.4103/0971-9903.202013
54
14. Yuan Lei, Medical Ventilator System Basics, Oxford University Press (2017)
55

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Measurement of Flow and Pressure Drop across

under the guidance of

Department of Mechanical Engineering

Head, Department of Mechanical Engineering

Pratik Vaidya Dr. Rashmi Uddanwadikar

First and foremost, I would like to express my heartfelt respect and

Secondly, I would like to express my infinite gratitude to Dr. Satish

Keywords: Endotracheal tube, Obstruction, Flow Resistance

Ch. Figure Page

Ch. Table Page

Sr. No Content Page No.

1.1 Mechanical Ventilation

If performed appropriately, mechanical ventilation is a powerful and effective life-

A set of specialized medical equipment is essential to perform this therapy. This

(1) compressed gas (oxygen and air) supplies,

(2) An electrical power supply,

(4) A breathing circuit,

(5) An artificial airway, and

(6) The patient’s pulmonary system.

A ventilator, therefore, is just one part of a ventilator system.

Mechanical ventilation is a cornerstone of intensive care in severely ill patients of all

 Invasive Ventilation (Requires intubation)

Resistance of the fluid in airway of respiratory system is flow dependent. Whenever

The following factors determine the magnitude of resistance:

 Intubation decreases the effective cross section of the airway, resulting in a

1.3. Artificial Airway resistance

A breathing circuit with an external airway mechanism termed as artificial airway

Fig. 1.2: Artificial airway and patient interface [14]

Where, R = resistance, n = viscosity, l = length, and r = radius of the ETT.

The ventilators are designed with various triggering mechanism according to

Table 1.1: Characteristics of mechanical breath types

The pressure drop across the ETT depends on

Also, the sources of various obstructions in the tube are:

i. Peak inspiratory pressure (PIP)

Peak inspiratory pressure (PIP)

i) PIP in a volume breath

ii) PIP in a pressure breath

Plateau pressure (Pplateau )

Mean airway pressure (MAP)

1.5. Operating principles

1. Intermittent positive pressure ventilation (IPPV)

2. Intermittent negative pressure ventilation (INPV)

When the alveolar pressure is reduced by applying a negative pressure on

3. High-frequency ventilation (HFV)

One of the most complex mechanisms of the ventilation is high- frequency

Fig 1.7: High Frequency Ventilation [14]

LITERATURE REVIEW &

AIM AND OBJECTIVES OF STUDY

To better understand the problem associated with the obstruction in

Roland Hentschel1, Julia Buntzel, Josef Guttmann and Stefan Schumann

The results from this experimentations shows that, the magnitude of

Computational Fluid Dynamics Modeling of Respiratory Airflow in

The project titled ‘Pressure drop across neonatal endotracheal tubes

P. M. Bolder, T. E. J. Healy, A. R. Bolder, P. c. w. Beatty and B. Kay

Results shows that work increases whenever endotracheal tube diameter

G. Conti, R.A. De Blasi, A. Lappa, A. Ferretti, M. Antonelli, M. Buff,

The conclusion drawn is, When precise measurements of ohmic

Behzad Maghsoodi, Golnar Sabetian, Aram Azimi, Nader Tanideh and

Data analysis revealed that sound intensity level decreased significantly

‘Resistance of neonatal endotracheal tubes: a comparison of four

Christian Straus, Bruno Louis, Daniel Isabey, François Lemaire, Alain

A case report by Anirudha Das, Shwetha Chagalamarri, and Kim

J. Guttmann, L. Eberhard, C. Haberthür, G. Mols, V. Kessler, M.

The study concluded that an ETT obstruction can be reliably