From the Division of Anaesthesia and Intensive Care Medicine, Addenbrooke's Hospital, Cambridge, UK.
Eur J Anaesthesiol. 2014 Mar;31(3):166-71. doi: 10.1097/EJA.0000000000000009.
Ventilation-associated pneumonia (VAP) is the commonest nosocomial infection in intensive care. Implementation of a VAP prevention care bundle is a proven method to reduce its incidence. The UK care bundle recommends maintenance of the tracheal tube cuff pressure at 20 to 30 cmH₂O with 4-hourly pressure checks and use of tracheal tubes with subglottic aspiration ports in patients admitted for more than 72 h.
To evaluate the effects of tracheal tube type and cuff pressure monitoring technique on leakage of subglottic secretions past the tracheal tube cuff.
Bench-top study.
Laboratory.
A model adult trachea with simulated subglottic secretions was intubated with a tracheal tube with the cuff inflated to 25 cmH₂O. Experiments were conducted using a Portex Profile Soft Seal tracheal tube with three cuff pressure monitoring strategies and using a Portex SACETT tracheal tube with intermittent cuff pressure checks.
Rate of simulated secretion leakage past the tracheal tube cuff.
Mean ± SD leakage of fluid past the Profile Soft Seal tracheal tube cuff was 2.25 ± 1.49 ml min⁻¹ with no monitoring of cuff pressure, 2.98 ± 1.63 ml min⁻¹ with intermittent cuff pressure monitoring and 3.83 ± 2.17 ml min⁻¹ with continuous cuff pressure monitoring (P <0.001). Using a SACETT tracheal tube with a subglottic aspiration port and aspirating the simulated secretions prior to intermittent cuff pressure checks reduced the leakage rate to 0.50 ± 0.48 ml min⁻¹ (P <0.001).
Subglottic secretions leaked past the tracheal tube cuff with all tube types and cuff pressure monitoring strategies in this model. Significantly higher rates were observed with continuous cuff pressure monitoring and significantly lower rates were observed when using a tracheal tube with a subglottic aspiration port. Further evaluation of medical device performance is needed in order to design more effective VAP prevention strategies.
呼吸机相关性肺炎（VAP）是重症监护病房中最常见的医院获得性感染。实施 VAP 预防护理包是降低其发病率的一种经过验证的方法。英国护理包建议，对于入住超过 72 小时的患者，将气管导管套囊压力维持在 20 至 30cmH₂O，并每 4 小时检查一次压力，使用带有声门下吸引端口的气管导管。
评估气管导管类型和套囊压力监测技术对声门下分泌物漏过气管导管套囊的影响。
台式研究。
实验室。
使用模拟声门下分泌物的成人气管模型，将气管导管插入气管，将导管套囊充气至 25cmH₂O。使用三种套囊压力监测策略对 Portex Profile Soft Seal 气管导管进行实验，并使用 Portex SACETT 气管导管间歇性检查套囊压力。
模拟分泌物漏过气管导管套囊的速率。
在未监测套囊压力时，Portex Profile Soft Seal 气管导管套囊的平均液体泄漏率为 2.25±1.49ml/min，间歇性监测套囊压力时为 2.98±1.63ml/min，连续监测套囊压力时为 3.83±2.17ml/min（P<0.001）。使用带有声门下吸引端口的 SACETT 气管导管，并在间歇性监测套囊压力前抽吸模拟分泌物，可将泄漏率降低至 0.50±0.48ml/min（P<0.001）。
在该模型中，所有类型的气管导管和套囊压力监测策略都有声门下分泌物漏出。连续监测套囊压力时观察到的泄漏率显著更高，使用带有声门下吸引端口的气管导管时观察到的泄漏率显著更低。需要进一步评估医疗器械性能，以便设计更有效的 VAP 预防策略。
