Vance Amanda, Hofmeister Erik H, Laas Cody, Williams Jamie
College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.
Vet Anaesth Analg. 2011 May;38(3):203-7. doi: 10.1111/j.1467-2995.2011.00610.x.
The purpose of this study was to investigate the effect of extubation with the endotracheal tube (ETT) cuff inflated versus deflated on endotracheal fluid volume in normal canine cadavers.
Prospective randomized blinded controlled cadaver study.
Sixteen adult Beagle cadavers weighing 10.7 ± 1.7 kg (mean ± SD) and <2 years of age.
Cadavers were orotracheally intubated in lateral recumbency, and the ETT cuffs were inflated to a closing pressure of 20 cm H2O before barium was introduced orad to the cuff. The dogs were randomly assigned to an ETT cuff extubation condition of deflated or unchanged from the original closing pressure. After extubation, lateral thoracic radiographs of the cadavers were obtained and scored by three independent blinded reviewers. Each reviewer ordered all 16 lateral radiographs from most to least intratracheal contrast and also estimated residual intratracheal contrast volume.
Dogs extubated with a deflated ETT cuff had a median rank of 13 and dogs extubated with an inflated ETT cuff had a median rank of 4.5 (p<0.0001). Dogs extubated with a deflated ETT cuff had an estimated intratracheal volume of fluid of 1.8 mL ± 0.7 mL (mean ± SD) and dogs extubated with an inflated ETT cuff had an estimated volume of 0.9 mL ± 0.5 mL (p < 0.0001). Fleiss Kappa for agreement among evaluators was 0.875.
Extubation with the cuff inflated removed more liquid contents from the trachea than extubation with the cuff deflated and may assist in the prevention of pulmonary aspiration when fluid is present in the proximal trachea. The technique did not remove all fluid so the potential for pulmonary damage remains.
本研究旨在探讨在正常犬类尸体中，气管插管（ETT）套囊充气与放气时拔管对气管内液体量的影响。
前瞻性随机双盲对照尸体研究。
16只成年比格犬尸体，体重10.7±1.7千克（均值±标准差），年龄小于2岁。
将尸体侧卧进行经口气管插管，在将钡剂引入套囊上方之前，将ETT套囊充气至闭合压力20 cm H₂O。将犬随机分配至ETT套囊放气或维持原始闭合压力的拔管条件。拔管后，获取尸体的胸部侧位X线片，并由三名独立的盲法评估者进行评分。每位评估者将所有16张侧位X线片按气管内造影剂从多到少排序，并估计气管内造影剂残留量。
ETT套囊放气时拔管的犬，中位排名为13；ETT套囊充气时拔管的犬，中位排名为4.5（p<0.0001）。ETT套囊放气时拔管的犬，气管内液体估计量为1.8 mL±0.7 mL（均值±标准差）；ETT套囊充气时拔管的犬，估计量为0.9 mL±0.5 mL（p<0.0001）。评估者间的Fleiss Kappa一致性系数为0.875。
套囊充气时拔管比套囊放气时拔管能从气管中清除更多液体成分，当气管近端存在液体时，可能有助于预防肺误吸。该技术并未清除所有液体，因此肺损伤的可能性仍然存在。
