Sandhu R S, Pasquale M D, Miller K, Wasser T E
Department of Surgery, Lehigh Valley Hospital, Allentown, PA 18105-1556, USA.
J Am Coll Surg. 2000 Jun;190(6):682-7. doi: 10.1016/s1072-7515(00)00269-6.
The purpose of this study was to determine the predictive value of an endotracheal tube cuff leak for the development of postextubation stridor and the need for reintubation.
Consecutive trauma patients who required intubation at a level I trauma center from July 1997 to July 1998 were studied prospectively. Pediatric patients and those who did not meet the standard weaning protocol criteria established by the Division of Trauma and Surgical Critical Care were excluded. Injury Severity Score, endotracheal tube size, reason for intubation, and the number of days intubated before the initial extubation attempt were recorded. At the time of extubation, the difference in exhaled tidal volume from before to after endotracheal tube cuff deflation was calculated. This number was then divided by the exhaled tidal volume before cuff deflation and was recorded as the percent cuff leak. Patients were followed for 24 hours after extubation for the development of stridor or need for reintubation. Statistical analysis to compare subgroups of patients was performed using ANOVA with Scheffé post hoc analysis.
Among the 110 patients analyzed, the most common reason for intubation was closed-head injury. Seven patients (6.4%) developed stridor alone and had a mean cuff leak of 5 8 mL (8.4% of tidal volume before cuff deflation). Six patients (5.5%) experienced stridor that required reintubation and had a mean cuff leak of 68 mL (9.2% of tidal volume before cuff deflation). Patients who developed stridor or needed reintubation had been intubated for a significantly greater length of time than those not developing stridor or requiring reintubation (2.6 versus 3.0 days, p < 0.001). There were no differences in Injury Severity Score, endotracheal tube size, or reason for intubation between these groups.
A cuff leak of less than 10% of tidal volume before cuff deflation is useful in identifying patients at risk for stridor or reintubation (96% specificity). It appears that the amount of cuff leak decreases after intubation for more than 3 days, increasing the risk of stridor and need for reintubation. This information may be helpful in identifying those patients who need treatment for laryngotracheal edema, ie, use of steroids or anesthesia during extubation, the efficacy of which remains to be determined.
本研究的目的是确定气管插管套囊漏气对拔管后喘鸣发生及再次插管需求的预测价值。
对1997年7月至1998年7月在一级创伤中心需要插管的连续创伤患者进行前瞻性研究。排除儿科患者以及不符合创伤与外科重症监护科制定的标准撤机方案标准的患者。记录损伤严重程度评分、气管插管尺寸、插管原因以及首次拔管尝试前的插管天数。在拔管时，计算气管插管套囊放气前后呼出潮气量的差值。然后将该数值除以套囊放气前的呼出潮气量，并记录为套囊漏气百分比。拔管后对患者进行24小时随访，观察喘鸣的发生情况或再次插管的需求。使用方差分析和谢费尔事后分析对患者亚组进行统计学分析比较。
在分析的110例患者中，最常见的插管原因是闭合性颅脑损伤。7例患者（6.4%）仅出现喘鸣，套囊平均漏气58毫升（占套囊放气前潮气量的8.4%）。6例患者（5.5%）出现需要再次插管的喘鸣情况，套囊平均漏气68毫升（占套囊放气前潮气量的9.2%）。出现喘鸣或需要再次插管的患者插管时间明显长于未出现喘鸣或不需要再次插管的患者（2.6天对3.0天，p<未找到相关内容>）。这些组之间在损伤严重程度评分、气管插管尺寸或插管原因方面没有差异。
套囊放气前套囊漏气量小于潮气量的10%有助于识别有喘鸣或再次插管风险的患者（特异性为96%）。似乎插管超过3天后套囊漏气量会减少，增加了喘鸣和再次插管的风险。这些信息可能有助于识别那些需要治疗喉气管水肿的患者，即拔管期间使用类固醇或麻醉，其疗效仍有待确定。
