Mahmoodpoor Ata, Peyrovi-far Ali, Hamishehkar Hadi, Bakhtyiari Zhaleh, Mirinezhad Mir Mousa, Hamidi Masoud, Golzari Samad Eslam Jamal
Department of Anesthesiology and Intensive Care, General ICU, Shohada Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Acta Med Iran. 2013 Aug 7;51(7):461-6.
Because microaspiration of contaminated supraglottic secretions past the endotracheal tube cuff is considered to be central in the pathogenesis of pneumonia, improved design of tracheal tubes with new cuff material and shape have reduced the size and number of folds, which together with the addition of suction ports above the cuff to drain pooled subglottic secretions leads to reduced aspiration of oropharyngeal secretions. So we conducted a study to compare the prophylactic effects of polyurethane-cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes (ETT) on ventilator-associated pneumonia. This randomized clinical trial was carried out in a 12 bed surgical intensive care unit. 96 patients expected to require mechanical ventilation more than 96 hours were randomly allocated to one of three following groups: Polyvinyl chloride cuff (PCV) ETT, Polyurethane (PU) cylindrical Sealguard ETT and PU Taperguard ETT. Cuff pressure monitored every three hours 3 days in all patients. Mean cuff pressure didn't have significant difference between three groups during 72 hours. Pneumonia was seen in 11 patients (34%) in group PVC, 8 (25%) in Sealguard and 7 (21%) in Taperguard group. Changes in mean cuff pressure between Sealguard and PVC tubes and also between Taperguard and PVC tubes did not show any significant difference. There was no significant difference in overinflation between three groups. The use of ETT with PU material results in reducing ventilator-associated pneumonia compared to ETT with PVC cuff. In PU tubes Taperguard has less incidence of ventilator-associated pneumonia compared to Sealguard tubes.
由于气管插管套囊上方污染的声门上分泌物的微误吸被认为是肺炎发病机制的核心，采用新型套囊材料和形状改进气管导管设计，减少了褶皱的尺寸和数量，同时在套囊上方增加吸引口以引流声门下积聚的分泌物，从而减少了口咽分泌物的误吸。因此，我们开展了一项研究，比较聚氨酯圆柱形或锥形套囊气管导管与聚氯乙烯套囊气管导管对呼吸机相关性肺炎的预防效果。这项随机临床试验在一个拥有12张床位的外科重症监护病房进行。96例预计需要机械通气超过96小时的患者被随机分配到以下三组之一：聚氯乙烯套囊（PCV）气管导管、聚氨酯（PU）圆柱形密封卫士气管导管和PU锥形卫士气管导管。所有患者在3天内每3小时监测一次套囊压力。72小时内三组的平均套囊压力无显著差异。PVC组有11例患者（34%）发生肺炎，密封卫士组有8例（25%），锥形卫士组有7例（21%）。密封卫士导管与PVC导管之间以及锥形卫士导管与PVC导管之间的平均套囊压力变化无显著差异。三组之间的过度充气无显著差异。与聚氯乙烯套囊气管导管相比，使用聚氨酯材料的气管导管可降低呼吸机相关性肺炎的发生率。在聚氨酯导管中，锥形卫士导管的呼吸机相关性肺炎发生率低于密封卫士导管。
