Kapadia F N, Bajan K B, Singh S, Mathew B, Nath A, Wadkar S
Department of Intensive Care, Hinduja National Hospital & Medical Research Center, Mumbia, India.
Intensive Care Med. 2001 Jan;27(1):296-300. doi: 10.1007/s001340000762.
To document the changes in patterns of airway accidents in intubated patients.
Prospective recording of all airway accidents over two periods: 1994-1997 and 1998-1999.
Ventilated patients (5,046) intubated for 9,289 days over 4 years (1994-1997) and 2,932 ventilated patients intubated for 6,339 days over 2 years (1998-1999).
The incidence and pattern of airway accidents over a 2-year period were compared to an earlier similar analysis done in the previous 4 years.
The total accident rate in the 1994-1997 period was 36 in 5,046 patients over 9,289 intubated-patient days. The total accident rate in the period 1998-1999 was 20 in 2,932 patients over 6,339 intubated-patient days. The frequency of blocked tracheal tube increased to equal that of unplanned extubation (UE) of endotracheal tube (ETT) as the commonest airway accident. There were nine episodes of blocked tracheal tube in the two current years compared to four in the previous 4 years and there were nine episodes of UE in the two current years compared to 15 in the previous 4 years. There were a total of 18 ETT accidents in 2,930 patients over 5,309 ETT days compared to a total of two tracheostomy accidents in 67 patients over 1,030 tracheostomy days.
We noted a change of the pattern of airway accidents. We noted an increasing trend in the incidence of blocked tracheal tubes, associated with an increased duration of heat and moisture exchanger-filters use. We also noted that the incidence of tracheostomy tube accidents was similar to that of ETT accidents in the current study, unlike the earlier study where tracheostomy tube accidents were more frequent than ETT accidents. This was due to the elimination of tracheostomy tube displacements during the later study period. We associated this with the use of adjustable tracheostomy length tubes.
记录气管插管患者气道意外情况的变化模式。
前瞻性记录两个时间段（1994 - 1997年和1998 - 1999年）内所有气道意外情况。
4年（1994 - 1997年）期间5046例接受机械通气患者插管9289天，以及2年（1998 - 1999年）期间2932例接受机械通气患者插管6339天。
将2年期间气道意外情况的发生率和模式与前4年进行的类似早期分析进行比较。
1994 - 1997年期间，5046例患者在9289个气管插管日中的总意外发生率为36次。1998 - 1999年期间，2932例患者在6339个气管插管日中的总意外发生率为20次。气管导管堵塞的频率增加至与气管内插管意外拔管（UE）相当，成为最常见的气道意外情况。在当前两年中有9次气管导管堵塞事件，而前4年为4次；当前两年中有9次意外拔管事件，而前4年为15次。在2930例患者的5309个气管内插管日中共有18次气管内插管意外，而在67例患者的1030个气管造瘘日中共有2次气管造瘘意外。
我们注意到气道意外情况的模式发生了变化。我们注意到气管导管堵塞的发生率呈上升趋势，这与热湿交换过滤器的使用时间增加有关。我们还注意到，在当前研究中气管造瘘管意外的发生率与气管内插管意外相似，这与早期研究不同，早期研究中气管造瘘管意外比气管内插管意外更频繁。这是由于在后期研究期间气管造瘘管移位情况减少。我们将此与可调节长度的气管造瘘管的使用相关联。
