Britton Tyler, Blakeman Thomas C, Eggert John, Rodriquez Dario, Ortiz Heather, Branson Richard D
From the CSTARS Cincinnati (T.B., J.E., D.R.); and University of Cincinnati (T.C.B., R.D.B.), Cincinnati; and 711th Human Performance Wing Wright-Patterson Air Force Base (H.O.), Dayton, Ohio.
J Trauma Acute Care Surg. 2014 Sep;77(3 Suppl 2):S240-4. doi: 10.1097/TA.0000000000000339.
Ascent to altitude results in the expansion of gases in closed spaces. The management of overinflation of the endotracheal tube (ETT) cuff at altitude is critical to prevent mucosal injury.
We continuously measured ETT cuff pressures during a Critical Care Air Transport Team training flight to 8,000-ft cabin pressure using four methods of cuff pressure management. ETTs were placed in a tracheal model, and mechanical ventilation was performed. In the control ETT, the cuff was inflated to 20 mm Hg to 22 mm Hg and not manipulated. The manual method used a pressure manometer to adjust pressure at cruising altitude and after landing. A PressureEasy device was connected to the pilot balloon of the third tube and set to a pressure of 20 mm Hg to 22 mm Hg. The final method filled the balloon with 10 mL of saline. Both size 8.0-mm and 7.5-mm ETT were studied during three flights.
In the control tube, pressure exceeded 70 mm Hg at cruising altitude. Manual management corrected for pressure at altitude but resulted in low cuff pressures upon landing (<10 mm Hg). The PressureEasy reduced the pressure change to a maximum of 36 mm Hg, but on landing, cuff pressures were less than 15 mm Hg. Saline inflation ameliorated cuff pressure changes at altitude, but initial pressures were 40 mm Hg.
None of the three methods using air inflation managed to maintain cuff pressures below those associated with tracheal damage at altitude or above pressures associated with secretion aspiration during descent. Saline inflation minimizes altitude-related alteration in cuff pressure but creates excessive pressures at sea level. New techniques need to be developed.
上升到高海拔会导致封闭空间内的气体膨胀。管理高海拔时气管内插管（ETT）套囊过度充气对于预防黏膜损伤至关重要。
在一次重症护理空中运输团队训练飞行中，我们使用四种套囊压力管理方法，持续测量了ETT套囊压力，飞行目的地为客舱压力8000英尺的地方。将ETT置于气管模型中，并进行机械通气。在对照ETT中，套囊充气至20毫米汞柱至22毫米汞柱，且不进行操作。手动方法使用压力计在巡航高度和着陆后调整压力。将PressureEasy装置连接到第三根导管的 pilot 球囊上，并设置为20毫米汞柱至22毫米汞柱的压力。最后一种方法是向球囊内注入10毫升生理盐水。在三次飞行中对8.0毫米和7.5毫米尺寸的ETT均进行了研究。
在对照导管中，巡航高度时压力超过70毫米汞柱。手动管理校正了高海拔时的压力，但着陆时套囊压力较低（<10毫米汞柱）。PressureEasy将压力变化最大降低到36毫米汞柱，但着陆时套囊压力小于15毫米汞柱。生理盐水充气改善了高海拔时套囊压力的变化，但初始压力为40毫米汞柱。
三种使用空气充气的方法均未能将套囊压力维持在低于高海拔时与气管损伤相关的压力或低于下降过程中与分泌物误吸相关的压力水平。生理盐水充气可将与海拔相关的套囊压力变化降至最低，但在海平面会产生过高压力。需要开发新技术。
