Nseir Saad, Brisson Helene, Marquette Charles-Hugo, Chaud Pascal, Di Pompeo Christophe, Diarra Maimouna, Durocher Alain
Calmette Hospital, University Hospital of Lille, France.
Eur J Anaesthesiol. 2009 Mar;26(3):229-34. doi: 10.1097/eja.0b013e3283222b6e.
An endotracheal cuff pressure of 20-30 cmH(2)O is recommended. Underinflation and overinflation are associated with complications such as aspiration and tracheal wall damage. The aim of this study was to identify prevalence of, and risk factors for, endotracheal cuff underinflation and overinflation.
Prospective observational cohort study. All critically ill patients intubated with a high-volume lowpressure endotracheal tube were eligible. After manual adjustment of cuff pressure at 25 cmH(2)O, continuous recording of cuff pressure and airway pressure was performed for 8 h. Underinflation and overinflation of the endotracheal cuff were defined as cuff pressure less than 20 cmH(2)O and more than 30 cmH(2)O, respectively. In all patients, the time spent with normal cuff pressure or with underinflation or overinflation of the endotracheal cuff was measured. Univariate and multivariate analyses were used to determine risk factors for cuff underinflation and overinflation.
Eight hundred and eight hours of cuff pressure recordings were analysed in 101 patients. Eighteen per cent of study patients spent 100% of recording time with normal (20-30 cmH(2)O) cuff pressure. Fifty-four per cent of study patients developed cuff underinflation, 73% developed cuff overinflation, and 44% developed both. Thirty- three per cent of study patients developed underinflation or overinflation for more than 30 min. Absence of sedation [odds ratio (95% confidence interval)=2.51 (1-6), P=0.03] and duration of prior intubation [1.16 (1.04-1.29), P<0.01] were independently associated with cuff underinflation. No risk factor for overinflation could be determined. The percentage of time spent with underinflation significantly (P<0.01) increased during the recording period.
Variations in endotracheal cuff pressure are common in ICU patients. Duration of prior intubation and absence of sedation are independently associated with increased risk for cuff underinflation.
推荐气管内套管压力维持在20 - 30 cmH₂O。充气不足和充气过度会引发诸如误吸和气管壁损伤等并发症。本研究旨在确定气管内套管充气不足和充气过度的发生率及危险因素。
前瞻性观察队列研究。所有使用大容量低压气管内导管进行插管的重症患者均符合条件。在将套管压力手动调整至25 cmH₂O后，连续记录套管压力和气道压力8小时。气管内套管充气不足和充气过度分别定义为套管压力低于20 cmH₂O和高于30 cmH₂O。在所有患者中，测量套管压力正常、充气不足或充气过度的时长。采用单因素和多因素分析来确定套管充气不足和充气过度的危险因素。
对101例患者的808小时套管压力记录进行了分析。18%的研究患者在记录时间内套管压力均正常（20 - 30 cmH₂O）。54%的研究患者出现套管充气不足，73%出现套管充气过度，44%两者均出现。33%的研究患者充气不足或充气过度持续超过30分钟。未使用镇静剂[比值比（95%置信区间）=2.51（1 - 6），P = 0.03]和既往插管时长[1.16（1.04 - 1.29），P < 0.01]与套管充气不足独立相关。未确定充气过度的危险因素。在记录期间，充气不足的时长百分比显著增加（P < 0.01）。
ICU患者气管内套管压力变化常见。既往插管时长和未使用镇静剂与套管充气不足风险增加独立相关。
