By Inflame 
Vanderbilt University Medical Center (VUMC) has been awarded $7 million in research funding from the Patient-Centered Outcomes Research Institute (PCORI) to investigate the effects of breathing tube size on breathing, speaking, and swallowing in critically ill patients. This groundbreaking study, called the BREATHE trial, will address the significant variability in current recommendations and practices for breathing tube size.
The Scope of the Problem
Each year, approximately 2-3 million critically ill adults in the U.S. require breathing tubes, but nearly half of survivors experience voice box injuries, leading to long-term complications in breathing, speaking, and swallowing. Despite the risks, there is no consensus on the optimal size of breathing tubes for minimizing these injuries.
Dr. Jonathan Casey, co-principal investigator and assistant professor at VUMC, noted, “Current guidelines vary widely, and multiple reviews have called for research on the impact of tube size on patient outcomes.”
Dr. Alexander Gelbard, co-principal investigator and otolaryngology specialist, emphasized the importance of smaller breathing tubes: “We’ve seen that smaller tubes may reduce voice box injuries, but there’s a concern that they could prolong ventilation or lower survival rates. Our study aims to resolve these uncertainties.”
About the BREATHE Trial
The BREATHE trial will involve 3,180 patients from seven emergency departments and ICUs, comparing smaller and larger breathing tubes in two key areas:
- Patient-Centered Outcomes: Long-term effects on breathing, speaking, and swallowing.
- Safety: Impact on time spent on ventilation and overall survival rates.
The trial is led by VUMC’s Pragmatic Critical Care Research Group and involves collaborations with the North American Airway Collaborative and the Critical Illness, Brain Dysfunction, and Survivorship Center.
PCORI’s Role and Vision
PCORI Executive Director Nakela Cook, MD, MPH, praised the project’s focus on patient-centered research and real-world applications. “This study addresses a critical evidence gap and could lead to significant improvements in care for critically ill patients,” she said.
PCORI is an independent nonprofit organization that funds comparative clinical research to provide actionable insights for patients, caregivers, and clinicians.
Why This Research Matters
This trial has the potential to standardize practices for breathing tube placement, reducing the risk of long-term complications while ensuring patient safety. Its findings could benefit millions of critically ill patients annually, providing clarity and consistency in critical care practices.