🫁 Recently bronched a patient with a gunked up ETT and wonder how often this happens? 
369 ETTs cut and measured degree of blockage (see pic)
📊 Moderate blockage common (CICU 28%, MICU 17%)
🔑 Risks: coagulopathy, longer ventilation, closed suction
⚠️ Ppeak ↑ but not clinically useful as many blocked tubes did not have this elevation!
Full paper: https://lnkd.in/gKjXsmsj
Daily Archives: August 25, 2025
What does ‘purulent sputum’ even mean?
Just how reliable are bedside sputum assessments anyway? 📄 Schuiteman et al in hashtagjournal_CHESTCritCare American College of Chest Physicians Hayley Gershengorn https://lnkd.in/gD4BQUJu
📍 10 ventilated pts, videos/photos shown to 383 ICU staff
📍 Gold standard = gram stain PMNs
Results: ✅ Accuracy: 69% 🔍 Sensitivity: 58% 🔍 Specificity: 92% No difference by role.
Agreement was poor: 🎨 Color α=0.40 💧 Viscosity α=0.21 📦 Volume α=0.17
Take-home: Bedside purulence checks = low accuracy + low consistency → risk of VAP overdiagnosis & unnecessary antibiotics!