Sridermma Sirinthip, Limtangturakool Sarawut, Wongsurakiat Phunsup, Thamlikitkul Visanu
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2007 Nov;90 Suppl 2:74-8.
Hyperinflation of endotracheal tube cuff causes tracheal mucosal damage and underinflation increases the risk of pneumonia. The current practice on inflation of endotracheal tube cuff in the intubated patients hospitalized at Siriraj Hospital uses the estimation method. The authors determined appropriateness of such current practice and developed an appropriate procedure for inflation of endotracheal tube cuff in intubated patients.
The endotracheal tube cuff pressures of 34 intubated patients in Siriraj Hospital were measured by manometer once daily. Inflation of the endotracheal tube cuffs of 20 patients was done and the volume of air required to optimize the intracuff pressure of 25 cmH2O was recorded. The intracuff pressure was measured every one hour for eight consecutive hours in the patients who had initial intracuff pressure of 25 cmH2O and 30 cmH2O. The nurses in the experimental wards used a manometer as a guide to inflate endotracheal tube cuff until the intracuff pressure was 30 cmH2O every eight hours, whereas the control wards used conventional procedures to inflate the endotracheal tube cuff. The endotracheal tube cuff pressures of the patients in both groups were measured twice daily.
Only 34% of intracuff pressure measurements were 20-30 cmH2O. The mean volume of inflated air required to achieve an intracuff pressure of 25 cmH2O was 7.1 ml. An initial intracuff pressure of 30 cmH2O decreased to 20 cmH2O at 7 to 9 hours after inflation. The rate of optimum endotracheal tube cuff pressure was 90.5% in the group guided by manometer and 31.8% in the conventional procedure group (p < 0.001, RR 2.85, 95% CI 2.44-3.32).
Inflation of endotracheal tube cuff should be guided by manometer to achieve a pressure of 30 cmH2O every eight hours.
气管内导管套囊过度充气会导致气管黏膜损伤，而充气不足会增加肺炎风险。诗里拉吉医院住院的插管患者目前采用估计法来进行气管内导管套囊的充气操作。作者确定了这种现行做法的合理性，并为插管患者制定了合适的气管内导管套囊充气程序。
诗里拉吉医院34例插管患者的气管内导管套囊压力每天用压力计测量一次。对20例患者的气管内导管套囊进行充气，并记录将套囊内压力优化至25 cmH₂O所需的空气量。对初始套囊内压力为25 cmH₂O和30 cmH₂O的患者连续八小时每小时测量一次套囊内压力。实验病房的护士以压力计为指导，每八小时对气管内导管套囊进行充气，直到套囊内压力达到30 cmH₂O，而对照病房采用传统程序对气管内导管套囊进行充气。两组患者的气管内导管套囊压力每天测量两次。
只有34%的套囊内压力测量值在20 - 30 cmH₂O之间。达到25 cmH₂O套囊内压力所需的平均充气量为7.1 ml。初始套囊内压力为30 cmH₂O在充气后7至9小时降至20 cmH₂O。在压力计指导组中，气管内导管套囊压力达到最佳值的比例为90.5%，在传统程序组中为31.8%（p < 0.001，RR 2.85，95% CI 2.44 - 3.32）。
气管内导管套囊充气应以压力计为指导，每八小时达到30 cmH₂O的压力。
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