Dosemeci Levent, Yilmaz Murat, Gürpinar Firuze, Ramazanoglu Atilla
Department of Anesthesiology and Intensive Care Medicine, Hospital of Akdeniz University, Dumlupinar Cad PK, 07070 Antalya, Turkey.
Intensive Care Med. 2002 Jan;28(1):63-7. doi: 10.1007/s00134-001-1161-x. Epub 2001 Nov 29.
To evaluate the safety and efficiency of the use of the laryngeal mask airway (LMA) during percutaneous dilatational tracheostomy under bronchoscopic guidance comparing with the ventilation via endotracheal tube (ET).
Prospective, randomized clinical trial in the eight-bed general intensive care unit of a university hospital.
60 consecutive adult critically ill patients who required elective tracheostomy for a period of 12 months.
Patients were randomly assigned to ventilated via LMA ( n=30 patients), and to ventilated via ET ( n=30).
Blood samples for arterial blood gas analyses were taken before the procedure (first value) and just before the insertion of tracheostomy tube (second value). There was no significant difference in pH, PaO2, or PaCO2 between groups before the procedure. The operating time was significantly shorter in LMA group (4.5+/-0.8 min versus 5.9+/-1.4 min). Although the second PaCO2 values were higher than the first in both groups, the rise in was significantly higher in ET group (6.8+/-3.5 mmHg vs. 4.5+/-2.4 mmHg). Hypercarbia was noted in 10 patients (38.5%) in the LMA group and 17 (56.7%) in the ET group. The decrease in pH related to hypercarbia was noted in both groups, but it was more significant in the ET group ( p<0.05).
LMA is an effective and successful ventilatory device during percutaneous dilatational tracheostomy. It improves visualization of the trachea and larynx during fiberoptic-assisted percutaneous dilatational tracheostomy and prevents the difficulties associated with the use of ET such as cuff puncture, tube transection by the needle, and accidental extubation. The use of a bronchoscope and the puncture of the ET cuff cause major increases in PaCO2.
比较在支气管镜引导下经皮扩张气管切开术中使用喉罩气道（LMA）与经气管内插管（ET）通气的安全性和有效性。
在一所大学医院拥有8张床位的综合重症监护病房进行的前瞻性随机临床试验。
连续60例成年危重症患者，他们在12个月内需要择期气管切开术。
患者被随机分配通过LMA通气（n = 30例患者）和通过ET通气（n = 30例）。
在手术前（第一个值）和即将插入气管切开管之前（第二个值）采集动脉血气分析的血样。手术前两组之间的pH、PaO2或PaCO2无显著差异。LMA组的手术时间明显更短（4.5±0.8分钟对5.9±1.4分钟）。尽管两组的第二个PaCO2值均高于第一个值，但ET组的升高幅度明显更高（6.8±3.5 mmHg对4.5±2.4 mmHg）。LMA组有10例患者（38.5%）出现高碳酸血症，ET组有17例（56.7%）。两组均观察到与高碳酸血症相关的pH下降，但在ET组更显著（p<0.05）。
LMA是经皮扩张气管切开术中一种有效且成功的通气装置。它在纤维支气管镜辅助经皮扩张气管切开术中改善了气管和喉部的视野，并避免了与使用ET相关的困难，如袖带穿刺、针切断导管和意外拔管。使用支气管镜和ET袖带穿刺会导致PaCO2大幅升高。
