Fuchs J, Schummer C, Giesser J, Bayer O, Schummer W
Department of Anaesthesiology and Intensive Care Medicine, Friedrich-Schiller-University Jena, Jena, Germany.
Acta Anaesthesiol Scand. 2007 Oct;51(9):1245-9. doi: 10.1111/j.1399-6576.2007.01437.x.
Insertion of a gastric tube (GT) in anaesthetized, paralyzed and intubated patients may be difficult. Tracheobronchial malposition of a GT may result in deleterious consequences. The purpose of this study was to determine the reliability of tracheal cuff pressure measurement to detect endobronchial malposition of GTs. We compared this new method with the measurement of exhaled CO(2) through the GT.
Thirty patients under general anesthesia and orotracheal intubation were analysed. First, the cuff pressure of the low-volume endotracheal tube (ET; ID 7.0-8.5 mm) was increased to 40 cmH(2)O. Then, in a randomized fashion, the GT (18 Charrière) was inserted consecutively into the trachea and oesophagus or vice versa. Cuff pressure was monitored continuously while advancing the GT. Furthermore, a capnograph was connected to the gastric tube and the aspirated PCO(2) was monitored.
Advancement of the gastric tube into the oesophagus increased ET cuff pressure by 1 +/- 1 cmH(2)O, while endotracheal placement of the GT increased cuff pressure by 28 +/- 8 cmH(2)O (P < 0.001). Using an increase of >10 cmH(2)O in cuff pressure detected endotracheal malpositioning of the GT with 100% sensitivity and specificity. In 28 out of 30 cases, PCO(2) increased by more than 2.6 kPa. Thus, the PCO(2) approach failed to detect tracheal malpositioning in two cases resulting in a sensitivity of 93.3%.
In intubated patients, cuff pressure measurement during insertion of a gastric tube is a new, simple and reliable bedside method to detect endotracheal malpositioning of a GT.
在麻醉、瘫痪且已插管的患者中插入胃管（GT）可能会很困难。胃管发生气管支气管错位可能会导致有害后果。本研究的目的是确定测量气管导管套囊压力以检测胃管支气管内错位的可靠性。我们将这种新方法与通过胃管测量呼出二氧化碳的方法进行了比较。
对30例全身麻醉并经口气管插管的患者进行了分析。首先，将小容量气管内导管（ET；内径7.0 - 8.5 mm）的套囊压力增至40 cmH₂O。然后，以随机方式将胃管（18 Ch）依次插入气管和食管，或反之。在推进胃管时持续监测套囊压力。此外，将二氧化碳监测仪连接到胃管并监测吸出的PCO₂。
胃管插入食管会使气管导管套囊压力升高1±1 cmH₂O，而胃管插入气管则使套囊压力升高28±8 cmH₂O（P < 0.001）。使用套囊压力升高>10 cmH₂O来检测胃管的气管内错位，其敏感性和特异性均为100%。在30例病例中的28例中，PCO₂升高超过2.6 kPa。因此，PCO₂方法在两例中未能检测到气管错位，敏感性为93.3%。
在已插管患者中，插入胃管期间测量套囊压力是一种新的、简单且可靠的床边方法，可用于检测胃管的气管内错位。
