Jain Mukul Kumar, Tripathi Chander Bushan
Department of Neuroanesthesiology, Institute of Human Behavior and Allied Sciences, Dilshad Garden, Delhi, India.
J Anaesthesiol Clin Pharmacol. 2011 Jul;27(3):358-61. doi: 10.4103/0970-9185.83682.
Inflation and assessment of the endotracheal tube cuff pressure is often not appreciated as a critical aspect of endotracheal intubation. Appropriate endotracheal tube cuff pressure, endotracheal intubation seals the airway to prevent aspiration and provides for positive-pressure ventilation without air leak.
Correlations between manual methods of assessing the pressure by an experienced anesthesiologists and assessment with maintenance of the pressure within the normal range by the automated pressure controller device were studied in 100 patients divided into two groups. In Group M, endotracheal tube cuff was inflated manually by a trained anesthesiologist and checked for its pressure hourly by cuff pressure monitor till the end of surgery. In Group C, endotracheal tube cuff was inflated by automated cuff pressure controller and pressure was maintained at 25-cm H(2)O throughout the surgeries. Repeated measure ANOVA was applied.
Repeated measure ANOVA results showed that average of endotracheal tube cuff pressure of 50 patients taken at seven different points is significantly different (F-value: 171.102, P-value: 0.000). Bonferroni correction test shows that average of endotracheal tube cuff pressure in all six groups are significantly different from constant group (P = 0.000). No case of laryngomalacia, tracheomalacia, tracheal stenosis, tracheoesophageal fistula or aspiration pneumonitis was observed.
Endotracheal tube cuff pressure was significantly high when endotracheal tube cuff was inflated manually. The known complications of high endotracheal tube cuff pressure can be avoided if the cuff pressure controller device is used and manual methods cannot be relied upon for keeping the pressure within the recommended levels.
气管内插管时气囊压力的充气及评估常未被视为关键环节。合适的气管内导管气囊压力能密封气道以防止误吸，并在无漏气的情况下实现正压通气。
将100例患者分为两组，研究经验丰富的麻醉医生手动评估压力的方法与自动压力控制器装置将压力维持在正常范围内的评估方法之间的相关性。在M组，由训练有素的麻醉医生手动给气管内导管气囊充气，并通过气囊压力监测仪每小时检查一次压力，直至手术结束。在C组，通过自动气囊压力控制器给气管内导管气囊充气，并在整个手术过程中将压力维持在25 cmH₂O。应用重复测量方差分析。
重复测量方差分析结果显示，50例患者在七个不同时间点测得的气管内导管气囊压力平均值存在显著差异（F值：171.102，P值：0.000）。Bonferroni校正检验表明，所有六组的气管内导管气囊压力平均值与恒定组均存在显著差异（P = 0.000）。未观察到喉软化、气管软化、气管狭窄、气管食管瘘或吸入性肺炎的病例。
手动给气管内导管气囊充气时，气囊压力显著偏高。如果使用气囊压力控制器装置，可避免已知的高气管内导管气囊压力并发症，且不能依靠手动方法将压力维持在推荐水平。
