不同湿化系统对气管导管通畅性的长期影响：采用声反射法进行评估

Long-term effects of different humidification systems on endotracheal tube patency: evaluation by the acoustic reflection method.

作者信息

Jaber Samir, Pigeot Jérôme, Fodil Redouane, Maggiore Salvatore, Harf Alain, Isabey Daniel, Brochard Laurent, Louis Bruno

机构信息

Service de Réanimation Médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris 12, France.

出版信息

Anesthesiology. 2004 Apr;100(4):782-8. doi: 10.1097/00000542-200404000-00006.

DOI:10.1097/00000542-200404000-00006

PMID:15087611

Abstract

BACKGROUND

Accumulation of mucous secretions in an endotracheal tube (ETT) increases its resistance, and the amount of deposit may be affected by the quality of humidification and heating of the inspired gas.

METHODS

The authors assessed the impact of two humidification systems, a heated humidifier (HH) and a hygroscopic-hydrophobic heat and moisture exchanger (HME), on the ETT patency in patients selected to require mechanical ventilation for more than 48 h. This comparison was performed over two consecutive periods and used the acoustic reflection method, which characterizes the amount and site of ETT obstruction and allows estimating ETT inner volume and resistance. Measurements were performed three times a week over the period of mechanical ventilation. Comparisons were performed at mid duration and at the end of the mechanical ventilation period.

RESULTS

The HH was used in 34 patients, and the HME was used in 26 patients. The two groups had similar severity and duration of mechanical ventilation. At mid duration of mechanical ventilation (5.5 +/- 3.3 vs. 4.8 +/- 3.3 days; P = 0.4), no difference was observed in ETT volume and resistance between the two groups. At the end of the study period (10.5 +/- 5.8 vs. 9.6 +/- 6.3 days of mechanical ventilation; P = 0.4), ETT volume was reduced to a greater extent with HME than with HH (-3.3 +/- 2.9 vs. -5.1 +/- 2.5%; P = 0.008), and ETT resistance increased significantly more with the HME than with the HH (8.4 +/- 12.2 vs. 19.4 +/- 17.7%; P = 0.001).

CONCLUSION

Prolonged use of humidification systems results in progressive reduction of ETT patency, and to a greater extent with HMEs than with HHs.

摘要

背景

气管内导管（ETT）中黏液分泌物的积聚增加其阻力，且沉积物的量可能受吸入气体湿化和加热质量的影响。

方法

作者评估了两种湿化系统，即加热湿化器（HH）和吸湿 - 疏水型热湿交换器（HME），对选定需要机械通气超过48小时的患者ETT通畅性的影响。这种比较在两个连续时间段内进行，并使用声学反射法，该方法可表征ETT阻塞的量和部位，并能估计ETT内部容积和阻力。在机械通气期间每周进行三次测量。在机械通气中期和末期进行比较。

结果

34例患者使用HH，26例患者使用HME。两组机械通气的严重程度和持续时间相似。在机械通气中期（5.5±3.3天对4.8±3.3天；P = 0.4），两组之间的ETT容积和阻力无差异。在研究期末（机械通气10.5±5.8天对9.6±6.3天；P = 0.4），与HH相比，HME使ETT容积降低的程度更大（-3.3±2.9%对-5.1±2.5%；P = 0.008），且与HH相比，HME使ETT阻力增加得更显著（8.4±12.2%对19.4±17.7%；P = 0.001）。