Guglielminotti J, Alzieu M, Maury E, Guidet B, Offenstadt G
Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.
Chest. 2000 Oct;118(4):1095-9. doi: 10.1378/chest.118.4.1095.
To identify parameters that indicate retained secretions and the need for tracheal suctioning (TS) in patients receiving mechanical ventilation (MV).
Prospective observational study.
A 14-bed medical ICU in a 946-bed university hospital.
Sixty-six consecutive patients receiving MV.
Two successive tracheal suctions, TS1 and TS2, performed at a 2-h interval as usual patient care. Retained secretions were considered significant if the volume of secretions removed by TS2 was > 0.5 mL.
Variations between TS1 and TS2 of pulse oximetric saturation (SpO(2)), peak inspiratory pressure (Ppeak), tidal volume (VT), and Ramsay score were compared between patients with TS2 < or = 0.5 mL (group 1; n = 27) and patients with TS2 > 0.5 mL (group 2; n = 39). The presence of a sawtooth pattern on flow-volume loop displayed on the monitor screen of the ventilator and of respiratory sounds heard over the trachea before TS2 were compared between the two groups. Variations of Ppeak, VT, SpO(2), and Ramsay score between TS1 and TS2 did not differ between the two groups. However, group 2 had a sawtooth pattern (82% vs 29.6%; p = 0.0001) and respiratory sounds (66.6% vs. 25.9%; p = 0. 001) more frequently than group 1 before TS2. For the sawtooth pattern, the likelihood ratio (LR) of a positive test was 2.70 and the LR of a negative test was 0.25, while for respiratory sounds it was 2.50 and 0.45, respectively. When the presence of a sawtooth pattern and of respiratory sounds was combined, the LR of a positive test rose to 14.7 and the LR of a negative test was 0.42.
A sawtooth pattern and/or respiratory sounds over the trachea are good indicators of retained secretions in patients receiving MV and may indicate the need for TS. Conversely, the absence of a sawtooth pattern may rule out retained secretions.
确定在接受机械通气（MV）的患者中提示分泌物潴留及气管吸痰（TS）必要性的参数。
前瞻性观察性研究。
一所拥有946张床位的大学医院中的一间设有14张床位的内科重症监护病房。
66例连续接受MV的患者。
作为常规患者护理，每隔2小时连续进行两次气管吸痰，即TS1和TS2。如果TS2吸出的分泌物量>0.5 mL，则认为存在显著的分泌物潴留。
比较TS2≤0.5 mL的患者（第1组；n = 27）和TS2>0.5 mL的患者（第2组；n = 39）在TS1和TS2之间脉搏血氧饱和度（SpO₂）、吸气峰压（Ppeak）、潮气量（VT）及 Ramsay评分的变化。比较两组在TS2之前呼吸机监测屏幕上流量-容积环出现锯齿样波形的情况以及气管听诊呼吸音情况。两组之间TS1和TS2之间Ppeak、VT、SpO₂及Ramsay评分的变化无差异。然而，在TS2之前，第2组比第1组更频繁出现锯齿样波形（82% 对29.6%；p = 0.0001）和呼吸音（66.6% 对25.9%；p = 0.001）。对于锯齿样波形，阳性检测的似然比（LR）为2.70，阴性检测的LR为0.25，而对于呼吸音，分别为2.50和0.45。当同时存在锯齿样波形和呼吸音时，阳性检测的LR升至14.7，阴性检测的LR为0.42。
锯齿样波形和/或气管呼吸音是接受MV患者分泌物潴留的良好指标，可能提示需要进行TS。相反，无锯齿样波形可能排除分泌物潴留。
