Prevention of endotracheal tube occlusion through process of standardisation of humidification during mechanical ventilation in a neonatal intensive care unit: A quality improvement initiative
Restricted accessResearch articleFirst published online 2026
Prevention of endotracheal tube occlusion through process of standardisation of humidification during mechanical ventilation in a neonatal intensive care unit: A quality improvement initiative
With the objective of decreasing the incidence of endotracheal tube occlusion (ETO) by 25% in our neonatal intensive care unit, we identified potential causes of insufficient humidification, identified a lack of knowledge regarding the use of humidifiers during ventilation, and established a standard procedure. Subsequent improvement of practice, viz. standardising gas flow, keeping adequate water levels in the humidifying chamber, eliminating defective probes and providing interactive nurse training, achieved sustained reduction of ETO by 40% over a period of 32 weeks.
IqbalQYounusMMAhmedA, et al.Neonatal mechanical ventilation: indications and outcome. Indian J Crit Care Med2015; 19: 523–527.
2.
NolanJPKellyFE. Airway challenges in critical care. Anaesthesia2011; 66: 81–92.
3.
BoquéMCGualisBSandiumengeA, et al.Endotracheal tube intraluminal diameter narrowing after mechanical ventilation: use of acoustic reflectometry. Intensive Care Med2004; 30: 2204–2209.
4.
ShahCKollefMH. Endotracheal tube intraluminal volume loss among mechanically ventilated patients. Crit Care Med2004; 32: 120–125.
5.
HeyerLLouisBIsabeyD, et al.Noninvasive estimate of work of breathing due to the endotracheal tube. Anesthesiology1996; 85: 1324–1333.
CohenILWeinbergPFFeinIA, et al.Endotracheal tube occlusion associated with the use of heat and moisture exchangers in the intensive care unit. Crit Care Med1988; 16: 277–279.
8.
LelloucheFTailléSLefrançoisF, et al.Humidification performance of 48 passive airway humidifiers: comparison with manufacturer data. Chest2009; 135: 276–286.
9.
DoyleAJoshiMFrankP, et al.A change in humidification system can eliminate endotracheal tube occlusion. J Crit Care2011; 26: 637.e1–4.
10.
GonçalvesRLTsuzukiLMCarvalhoMG. Endotracheal suctioning in intubated newborns: an integrative literature review. Rev Bras Ter Intensiva2015; 27: 284–292.
11.
Al DorziHMGhanemAGHegazyMM, et al.Humidification during mechanical ventilation to prevent endotracheal tube occlusion in critically ill patients: a case control study. Ann Thorac Med2022; 17: 37–43.
12.
GonçalvesRLTsuzukiLMCarvalhoMG. Endotracheal suctioning in intubated newborns: an integrative literature review. Rev Bras Ter Intensiva2015; 27: 284–292.
13.
LelloucheFTailléSMaggioreSM, et al.Influence of ambient and ventilator output temperatures on performance of heated-wire humidifiers. Am J Respir Crit Care Med2004; 170: 1073–1079.
14.
Esquinas RodriguezAMScalaR, et al.Clinical review: humidifiers during non-invasive ventilation–key topics and practical implications. Crit Care2012; 16: 203.
15.
ToddDABoydJLloydJ, et al.Inspired gas humidity during mechanical ventilation: effects of humidification chamber, airway temperature probe position and environmental conditions. J Paediatr Child Health2001; 37: 489–494.
16.
FoyRSkrypakMAldersonS, et al.Revitalising audit and feedback to improve patient care. Br Med J2020; 368: m213.
17.
LehtonenLAxelinA. Medical champions can make a difference in initiating culture change. Acta Paediatr2016; 105: 994–995.
