Schubert A, Von Kaenel W, Ilyes L
Department of General Anesthesiology, Cleveland Clinic Foundation, OH 44195-5154.
J Clin Anesth. 1991 Jan-Feb;3(1):26-31. doi: 10.1016/0952-8180(91)90202-x.
To evaluate the effectiveness of methods for sealing a small endotracheal tube cuff perforation.
Randomized evaluation in an in vitro model of mechanical ventilation. In addition, two pertinent cases are reported.
Operative anesthesia service in a large tertiary referral center.
A transparent acrylic "trachea" attached to a rubber breathing bag ("lung") was intubated with an 8.0 mm endotracheal tube. Positive pressure mechanical ventilation was begun and baseline minute ventilation recorded. After equilibrium, the endotracheal tube cuff was perforated in a standard fashion, and one of four "treatments" was applied in random sequence. Group A endotracheal tubes (n = 7) were managed by increasing fresh gas flow and manually injecting air into the cuff. Group B cuffs (n = 8) were insufflated with oxygen to maintain cuff pressure at 25 to 28 mmHg. In Groups C (n = 8) and D (n = 9), an 8 ml mixture of 2% lidocaine hydrochloride jelly (Xylocaine, Astra, Westborough, MA), and saline was injected into the cuff at a dilution of 1:3 and 1:1, respectively.
Measurements included minute ventilation, airway pressure, and intracuff pressure. During the 30-minute observation period after cuff perforation, total exhaled ventilation was assessed and wasted ventilation calculated. Group A wasted ventilation (means +/- SD) was significantly greater (112 +/- 20 liters, p less than 0.01) than Groups B, C, and D (12 +/- 12 liters, 10 +/- 5 liters, and 18 +/- 13 liters, respectively). In Group A, it was impossible to maintain adequate minute ventilation. To remain inflated, Group B cuffs required insufflation at a rate of 10 to 80 ml/min. Groups C and D maintained an excellent cuff seal, but 2 of 9 Group D cuffs could not be deflated, while all Group C cuffs were deflatable. Also reported are two cases of persistent intraoperative endotracheal tube cuff leaks refractory to conventional management. Inflation of the endotracheal tube cuff with a lidocaine jelly-saline mixture successfully eliminated the leak, allowing completion of the procedure without reintubation.
The authors' in vitro results, in conjunction with the observations from their two cases, suggest that lidocaine jelly mixed with 1 to 3 parts normal saline may be useful in managing certain types of endotracheal tube cuff incompetence.
评估封闭小口径气管内导管套囊穿孔方法的有效性。
在机械通气体外模型中进行随机评估。此外，报告了两例相关病例。
一家大型三级转诊中心的手术麻醉科。
将一个连接橡胶呼吸袋（“肺”）的透明丙烯酸“气管”用一根8.0毫米的气管内导管进行插管。开始正压机械通气并记录基线分钟通气量。平衡后，以标准方式使气管内导管套囊穿孔，并随机依次应用四种“治疗”方法之一。A组气管内导管（n = 7）通过增加新鲜气体流量并手动向套囊内注入空气进行处理。B组套囊（n = 8）充入氧气以将套囊压力维持在25至28 mmHg。C组（n = 8）和D组（n = 9）分别以1:3和1:1的稀释度向套囊内注入8毫升2%盐酸利多卡因凝胶（赛罗卡因，阿斯特拉公司，马萨诸塞州韦斯特伯勒）和生理盐水的混合物。
测量指标包括分钟通气量、气道压力和套囊内压力。在套囊穿孔后的30分钟观察期内，评估总呼出通气量并计算无效通气量。A组的无效通气量（均值±标准差）显著高于B组、C组和D组（分别为112±20升，p<0.01；B组为12±12升，C组为10±5升，D组为18±13升）。在A组中，无法维持足够的分钟通气量。为保持膨胀，B组套囊需要以10至80毫升/分钟的速率充气。C组和D组保持了良好的套囊密封，但D组9个套囊中有2个无法放气，而C组所有套囊均可放气。还报告了两例术中气管内导管套囊持续漏气且常规处理无效的病例。用利多卡因凝胶 - 生理盐水混合物充盈气管内导管套囊成功消除了漏气，使手术得以完成而无需重新插管。
作者的体外研究结果，结合两例病例的观察，提示1至3份生理盐水与利多卡因凝胶混合可能有助于处理某些类型的气管内导管套囊功能不全。
