Bolzan Douglas Willian, Gomes Walter Jose, Peixoto Thatiana Cristina Alves, Faresin Sônia Maria, Carvalho Antônio Carlos de Camargo, De Paola Angelo Amato Vincenzo, Guizilini Solange
Cardiology Division.
Cardiology Division Cardiovascular Surgery Discipline, Pirajussara and São Paulo Hospitals, Federal University of São Paulo, São Paulo, Brazil.
Respir Care. 2014 Nov;59(11):1628-35. doi: 10.4187/respcare.02683. Epub 2014 Jun 10.
Previous investigation showed that the volume-time curve technique could be an alternative for endotracheal tube (ETT) cuff management. However, the clinical impact of the volume-time curve application has not been documented. The purpose of this study was to compare the occurrence and intensity of a sore throat, cough, thoracic pain, and pulmonary function between these 2 techniques for ETT cuff management: volume-time curve technique versus minimal occlusive volume (MOV) technique after coronary artery bypass grafting.
A total of 450 subjects were randomized into 2 groups for cuff management after intubation: MOV group (n = 222) and volume-time curve group (n = 228). We measured cuff pressure before extubation. We performed spirometry 24 h before and after surgery. We graded sore throat and cough according to a 4-point scale at 1, 24, 72, and 120 h after extubation and assessed thoracic pain at 24 h after extubation and quantified the level of pain by a 10-point scale.
The volume-time curve group presented significantly lower cuff pressure (30.9 ± 2.8 vs 37.7 ± 3.4 cm H2O), less incidence and intensity of sore throat (1 h, 23.7 vs 51.4%; and 24 h, 18.9 vs 40.5%, P < .001), cough (1 h, 19.3 vs 48.6%; and 24 h, 18.4 vs 42.3%, P < .001), thoracic pain (5.2 ± 1.8 vs 7.1 ± 1.7), better preservation of FVC (49.5 ± 9.9 vs 41.8 ± 12.9%, P = .005), and FEV1 (46.6 ± 1.8 vs 38.6 ± 1.4%, P = .005) compared with the MOV group.
The subjects who received the volume-time curve technique for ETT cuff management presented a significantly lower incidence and severity of sore throat and cough, less thoracic pain, and minimally impaired pulmonary function than those subjects who received the MOV technique during the first 24 h after coronary artery bypass grafting.
先前的研究表明，容量-时间曲线技术可作为气管内导管（ETT）套囊管理的一种替代方法。然而，容量-时间曲线应用的临床影响尚未见报道。本研究的目的是比较这两种ETT套囊管理技术在冠状动脉旁路移植术后咽喉痛、咳嗽、胸痛和肺功能的发生率及严重程度：容量-时间曲线技术与最小闭合容量（MOV）技术。
总共450名受试者在插管后被随机分为两组进行套囊管理：MOV组（n = 222）和容量-时间曲线组（n = 228）。我们在拔管前测量套囊压力。在手术前后24小时进行肺功能测定。我们在拔管后1、24、72和120小时根据四分制对咽喉痛和咳嗽进行分级，并在拔管后24小时评估胸痛情况，用十分制对疼痛程度进行量化。
与MOV组相比，容量-时间曲线组的套囊压力显著更低（30.9±2.8 vs 37.7±3.4 cm H₂O），咽喉痛的发生率和严重程度更低（1小时，23.7% vs 51.4%；24小时，18.9% vs 40.5%，P <.001），咳嗽发生率和严重程度更低（1小时，19.3% vs 48.6%；24小时，18.4% vs 42.3%，P <.001），胸痛情况更好（5.2±1.8 vs 7.1±1.7），用力肺活量（FVC）的保留情况更好（49.5±9.9% vs 41.8±12.9%，P =.005），第1秒用力呼气容积（FEV₁）的保留情况更好（46.6±1.8% vs 38.6±1.4%，P =.005）。
在冠状动脉旁路移植术后的头24小时内，接受容量-时间曲线技术进行ETT套囊管理的受试者，其咽喉痛和咳嗽的发生率及严重程度显著更低，胸痛更少，肺功能受损最小，优于接受MOV技术的受试者。
