Shann F A, Duncan A W, Brandstater B
Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria.
Anaesth Intensive Care. 2003 Dec;31(6):664-6; discussion 663-4.
Because tracheostomy has a very high complication rate in small children, prolonged mechanical ventilation was not performed satisfactorily in infants until a technique was developed that allowed prolonged per-laryngeal endotracheal intubation in children. Plastic polyvinyl chloride endotracheal tubes were introduced in the 1950s; they soften at body temperature, and are much less likely to cause subglottic stenosis than endotracheal tubes made from metal or rubber. The first account of prolonged per-laryngeal intubation of infants using polyvinyl chloride tubes was written by Dr Bernard Brandstater, and this remarkable document is reproduced here. It sets out all the important principles of endotracheal intubation in children: the tube must fit easily through the cricoid ring, it must be firmly fixed in place with the tip in the mid trachea, meticulous humidification and suction are essential, and the tube should be changed only if there are signs of obstruction.
由于气管切开术在幼儿中的并发症发生率非常高，在一种允许对儿童进行长时间喉周围气管插管的技术出现之前，婴儿的长时间机械通气效果并不理想。20世纪50年代引入了塑料聚氯乙烯气管导管；它们在体温下会变软，与由金属或橡胶制成的气管导管相比，引起声门下狭窄的可能性要小得多。伯纳德·布兰德施泰特医生撰写了首篇关于使用聚氯乙烯导管对婴儿进行长时间喉周围插管的报告，这份卓越的文档在此重现。它阐述了儿童气管插管的所有重要原则：导管必须能够轻松穿过环状软骨环，必须牢固固定在适当位置且尖端位于气管中部，细致的湿化和吸引至关重要，并且只有在出现梗阻迹象时才应更换导管。
