Reissmann Hajo, Böhm Stephan H, Suárez-Sipmann Fernando, Tusman Gerardo, Buschmann Claas, Maisch Stefan, Pesch Tanja, Thamm Oliver, Plümers Christoph, Schulte am Esch Jochen, Hedenstierna Göran
Department of Anesthesiology, Universitätsklinikum Hamburg-Eppendorf, Germany.
Intensive Care Med. 2005 Mar;31(3):431-40. doi: 10.1007/s00134-004-2537-5. Epub 2005 Feb 3.
Endotracheal suctioning can cause alveolar collapse and impede ventilation. One reason is the gas flow through a single-lumen endotracheal tube (ETT) provoking a gradient between airway opening and tracheal (P(tr)) pressures. Separately extending the patient tubing limbs of a suitable ventilator into the trachea via a double-lumen ETT should maintain P(tr). Can this technique reduce the side effects?
Bench and animal studies in a university hospital laboratory.
A lung model was ventilated via single and double-lumen ETTs. Closed-system suctioning was applied with catheters introduced into the single-lumen ETT or the expiratory lumen of the double-lumen ETT via swivel adapter. Seven anesthetized pigs (lungs lavaged) underwent three runs of ventilation and suctioning through (a, b) an 8.0-mm ID single-lumen ETT, (c) a double-lumen ETT (41Ch outer diameter, OD). In (a) the single-lumen ETT was disconnected for suctioning, in (b) and (c) ventilator mode was set to continuous positive airway pressure mode, and the ETTs remained connected.
Bench: Suction through single-lumen ETTs impaired ventilation and led to strongly negative P(tr) (common: -10 to -20 mbar); the double-lumen ETT technique maintained ventilation and pressures.
Lung gas content (computed tomography, n=4) and arterial oxygen partial pressure, initially 1462+/-65 ml/532+/-76 mmHg, were significantly reduced by suctioning through single-lumen ETT: to 302+/-79 ml/62+/-6 mmHg with disconnection and to 851+/-211 ml/158+/-107 mmHg with closed suction. With double-lumen ETT they remained at 1377+/-95 ml/521+/-56 mmHg.
The double-lumen ETT technique minimizes side effects of suctioning by maintaining P(tr).
气管内吸痰可导致肺泡塌陷并阻碍通气。原因之一是通过单腔气管内导管（ETT）的气流会在气道开口与气管（P(tr)）压力之间形成梯度。通过双腔ETT将合适呼吸机的患者管路分支分别延伸至气管内应能维持P(tr)。该技术能否减少副作用？
大学医院实验室的实验台和动物研究。
通过单腔和双腔ETT对肺模型进行通气。使用导管经旋转接头插入单腔ETT或双腔ETT的呼气腔进行封闭系统吸痰。七只麻醉猪（肺已灌洗）通过（a、b）外径8.0毫米的单腔ETT、（c）双腔ETT（外径41Ch）进行三轮通气和吸痰。在（a）中，断开单腔ETT进行吸痰；在（b）和（c）中，将呼吸机模式设置为持续气道正压模式，ETT保持连接。
实验台：通过单腔ETT吸痰会损害通气并导致P(tr)显著为负（常见：-10至-20毫巴）；双腔ETT技术可维持通气和压力。
通过单腔ETT吸痰会使肺气体含量（计算机断层扫描，n = 4）和动脉血氧分压（初始为1462±65毫升/532±76毫米汞柱）显著降低：断开连接时降至302±79毫升/62±6毫米汞柱，封闭吸痰时降至851±211毫升/158±107毫米汞柱。使用双腔ETT时，它们保持在1377±95毫升/521±56毫米汞柱。
双腔ETT技术通过维持P(tr)将吸痰的副作用降至最低。
