Pathways: Endotracheal Tube Design Improves Care

Girish Deshpande, MD, professor of clinical pediatrics, noticed the disruption unplanned extubations (UE) caused in pediatric ICUs and wanted to do something about it. He studied the mechanisms of UEs and set out to create a tube to lessen its occurrence. UEs occur when a patient’s breathing tube on a ventilator falls out sooner than the doctor’s decision to remove it.
With preliminary research in 2005, Deshpande realized UE was a universal problem occurring in all age groups (from neonates to adults). Once placed and secured, the endotracheal tube is subjected to multiple forces. These range from patient head movement, patient’s saliva, transport, and loosening of the adhesive tape used to hold the tube in place. In addition, after-market accessories, like in-line suction, and monitoring sensors put additional weight on the end of the endotracheal tube resulting in kinking the tube causing obstruction of the airflow as well as subject it to an additional outward pull further contributing to UEs.
UEs are more than an inconvenience, they impose a serious health risk to patients, and their mitigation is costly. UEs may result in soft tissue injury (such as vocal cords), hypoxemia, need for cardiopulmonary resuscitation, and emergent intubation, and may result in mortality. Ventilator-associated pneumonia and tracheobronchitis are other complications associated with UEs. These lead to prolonged days on a ventilator, longer ICU stays, and longer hospitalizations. UEs contribute to a significant increase in hospital expenditure thus increasing overall healthcare costs. In the United States each year, UEs in NICUs are responsible for $2.9 billion of healthcare costs and $4.9 billion for adults.
Deshpande’s solution is a novel endotracheal tube with features to mitigate various factors contributing to UEs. His design features two ports with securing places for each of them, with one away from oral secretions. It also eliminates the use of tape with its specialized holder. This design also distributes the weight of the accessories to reduce the chance of kinking and the outward pull on the tube. Its inbuilt bite block prevents obstruction due to biting. Deshpande believes that defining the problem well is foundational to solving it. He says, “Working in the ICU fuels my innovative ideas. If I had an engineer rounding with me in the ICU, we could change so many things!”
Working with the UIC Office of Technology Management, he applied for a provisional patent in 2007, followed by development of various prototypes, and after years of defending his patent with the US Patent Office his patent was published in 2015. His project has received funding support from a UIC Vice Chancellor Grant supporting Proof of Concept, Department of Pediatrics at UICOMP, Children’s Hospital, as well as through Philadelphia Pediatric Device Consortium Grant (a federal grant program) for the prototype development. Currently, he has formed a company and is working with investors and a third-party company to apply for regulatory clearance through FDA.
Following nearly two decades of research and work, Deshpande’s vision is that his improved endotracheal tube will improve health by decreasing UEs thus helping the patients, and decreasing the subsequent health risks, longer ICU stays, prolonged hospitalizations and the greater associated healthcare costs that accompany them.
This article is part of the Fall/Winter 2024-2025 issue of Pathways magazine.