Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital NHS Trust, Critical Care, King's Lynn, UK.
Nurs Crit Care. 2010 Sep-Oct;15(5):257-61. doi: 10.1111/j.1478-5153.2010.00422.x.
To estimate the ability of simulated tracheal suction, adjusting the positive end expiratory pressure (PEEP) settings on the ventilator or compressing a self-inflating bag to minimize aspiration during cuff deflation and extubation in a bench-top model.
During intubation, colonized secretions accumulate in the subglottic space above the endotracheal tube (ETT) cuff. Consequently, during cuff deflation and extubation, there is a risk of aspiration of the secretions. This may result in pneumonitis or pneumonia. There are a number of techniques used during cuff deflation and extubation to prevent secretion aspiration.
A model trachea was intubated and the proximal end of the ETT was attached to a mechanical ventilator. Ten millilitres of water was placed above the inflated cuff and then nine test protocols were implemented in a random order to simulate tracheal suction, adjusting the PEEP settings on the ventilator or compressing a self-inflating bag. The volume of water 'aspirated' by the model was determined by weighing the apparatus pre- and post-extubation. Statistical analysis was performed using regression analysis and heteroscedastic t tests with a Bonferroni correction.
The level of PEEP was negatively correlated with the volume of fluid aspirated [co-efficient -0.24 (99% confidence interval -0.31 to -0.17), R(2) = 0.75]. Significantly less fluid was aspirated when a PEEP of 35 cmH(2)O was applied when compared with competing techniques.
This study suggests that applying PEEP during cuff deflation and extubation is protective against aspiration. We conclude that unless there is a contraindication, the application of PEEP should be considered when extubating patients.
通过模拟气管吸引，调整呼吸机上的呼气末正压（PEEP）设置或压缩自膨式气囊，在台式模型中尽量减少在套囊放气和拔管期间的吸入。
在插管过程中，定植的分泌物在气管内导管（ETT）套囊上方的声门下空间积聚。因此，在套囊放气和拔管期间，存在分泌物吸入的风险。这可能导致肺炎或肺炎。在套囊放气和拔管期间，有许多技术用于防止分泌物吸入。
将模型气管插管，将 ETT 的近端连接到机械呼吸机。在充气套囊上方放置 10 毫升水，然后按照随机顺序实施九个测试方案，模拟气管吸引，调整呼吸机上的 PEEP 设置或压缩自膨式气囊。通过在拔管前和拔管后称重仪器来确定模型“吸入”的水量。使用回归分析和具有 Bonferroni 校正的异方差 t 检验进行统计分析。
PEEP 水平与吸入的液体量呈负相关[系数-0.24（99%置信区间-0.31 至-0.17），R²=0.75]。与竞争技术相比，在应用 35 cmH₂O 的 PEEP 时，吸入的液体明显减少。
本研究表明，在套囊放气和拔管期间应用 PEEP 可防止吸入。我们的结论是，除非有禁忌症，否则在为患者拔管时应考虑应用 PEEP。
