Background: Artificial airway resistance as provided by small-lumen tracheal tubes or catheters increases the risk of intrinsic PEEP (PEEPi). We hypothesized that by active expiration assistance, larger minute volumes could be generated without causing PEEPi compared with conventional mechanical ventilation when using small-lumen tracheal tubes or a cricothyrotomy catheter.
Methods: We investigated the active expiration assistance in a physical model of the respiratory system and estimated its hypothetical performance in terms of maximal flow generated with endotracheal tubes ranging from 3.