Ulrich-Pur Herbert, Hrska Franz, Krafft Peter, Friehs Helmut, Wulkersdorfer Beatrix, Köstler Wolfgang J, Rabitsch Werner, Staudinger Thomas, Schuster Ernst, Frass Michael
Intensive Care Unit 13i2, Department of Internal Medicine I, Medical University Vienna, Austria.
Anesthesiology. 2006 May;104(5):933-8. doi: 10.1097/00000542-200605000-00007.
High pressures exerted by balloons and cuffs of conventional endotracheal tubes, the Combitube (Tyco Healthcare Nellcor Mallinckrodt, Pleasanton, CA), the EasyTube (Teleflex Ruesch, Kernen, Germany), the Laryngeal Mask Airway (LMA North America, San Diego, CA), the Intubating Laryngeal Mask Airway (Fastrach; LMA North America), the ProSeal (LMA North America), and the Laryngeal Tube (LT; VBM Medizintechnik, Sulz, Germany) may traumatize the pharyngeal mucosa. The aim of this study was to compare pressures exerted on the pharyngeal, tracheal, and esophageal mucosa by different devices designed for securing the patient's airways.
Nineteen fresh cadavers were included. To measure mucosal pressures, microchip sensors were fixed on the anterior, lateral, and posterior surfaces of the proximal balloon and the distal cuff of the investigated devices. Depending on the respective airway device, the cuff volume was increased in 10-ml increments at the proximal balloon starting from 0 to a maximum of 100 ml, and in 2-ml increments at the distal cuff starting from 0 up to 12 ml.
Tracheal mucosal pressures were significantly higher using the Combitube compared with the endotracheal tube and the EasyTube. Maximal esophageal pressures were significantly higher using the EasyTube compared with the Combitube. Using cuff volumes according to the manufacturers' guidelines, we found the highest pharyngeal pressures with the Intubating Laryngeal Mask Airway versus all other devices. At maximal volumes, the Laryngeal Mask Airway, the Intubating Laryngeal Mask Airway, and the ProSeal induced significantly higher pharyngeal pressures compared with all other devices. Using a pharyngeal cuff volume of 40 ml, the Intubating Laryngeal Mask Airway followed by the Laryngeal Mask Airway exerted significantly higher pressures compared with the other devices.
Although some devices exhibit a somewhat higher mucosal pressure when compared with others, the authors believe that the observed differences of the cuff pressures do not suggest a clinically relevant danger, because the investigated devices, except the endotracheal tubes, are not intended for prolonged use.
传统气管内导管、食管气管联合导管（泰科医疗内尔科尔马利克罗斯特公司，加利福尼亚州普莱森顿）、简易气管导管（泰利福鲁施公司，德国克嫩）、喉罩气道（北美喉罩气道公司，加利福尼亚州圣地亚哥）、插管型喉罩气道（Fastrach；北美喉罩气道公司）、双管型喉罩气道（北美喉罩气道公司）和喉管（LT；VBM 医疗技术公司，德国苏尔茨）的球囊和套囊所施加的高压可能会损伤咽黏膜。本研究的目的是比较不同气道固定装置对咽、气管和食管黏膜施加的压力。
纳入 19 具新鲜尸体。为测量黏膜压力，将微芯片传感器固定在所研究装置近端球囊和远端套囊的前、侧和后表面。根据各自的气道装置，近端球囊的套囊容积从 0 开始以 10 ml 的增量增加至最大 100 ml，远端套囊从 0 开始以 2 ml 的增量增加至 12 ml。
与气管内导管和简易气管导管相比，使用食管气管联合导管时气管黏膜压力显著更高。与食管气管联合导管相比，使用简易气管导管时最大食管压力显著更高。按照制造商指南使用套囊容积时，我们发现与所有其他装置相比，插管型喉罩气道导致的咽压力最高。在最大容积时，与所有其他装置相比，喉罩气道、插管型喉罩气道和双管型喉罩气道导致的咽压力显著更高。使用 40 ml 的咽套囊容积时，与其他装置相比，插管型喉罩气道其次是喉罩气道施加的压力显著更高。
尽管与其他一些装置相比，某些装置的黏膜压力略高，但作者认为观察到的套囊压力差异并不表明存在临床相关危险，因为除气管内导管外，所研究的装置并非用于长期使用。
