机械通气患者的高分辨率计算机断层扫描评估的气管导管阻塞。

Tracheal tube obstruction in mechanically ventilated patients assessed by high-resolution computed tomography.

机构信息

From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts (C.M., R.P., A.P., R.M.K., L. Berra); School of Dentistry, West Virginia University, Morgantown, West Virginia (J.G.T.); Center for Clinical and Translational Metagenomics, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (L. Bry, M.L.D., A.D.B.); Center for System Biology, Massachusetts General Hospital, Boston, Massachusetts (J.T., G.R.W., M.N.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (J.B.A.); and Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts (R.M.K.).

出版信息

Anesthesiology. 2014 Dec;121(6):1226-35. doi: 10.1097/ALN.0000000000000455.

DOI:10.1097/ALN.0000000000000455

PMID:25254903

Abstract

BACKGROUND

Tracheal intubation compromises mucus clearance and secretions accumulate inside the tracheal tube (TT). The aim of this study was to evaluate with a novel methodology TT luminal obstruction in critically ill patients.

METHODS

This was a three-phase study: (1) the authors collected 20 TTs at extubation. High-resolution computed tomography (CT) was performed to determine cross-sectional area (CSA) and mucus distribution within the TT; (2) five TTs partially filled with silicone were used to correlate high-resolution CT results and increased airflow resistance; and (3) 20 chest CT scans of intubated patients were reviewed for detection of secretions in ventilated patients' TT.

RESULTS

Postextubation TTs showed a maximum CSA reduction of (mean±SD) 24.9±3.9% (range 3.3 to 71.2%) after a median intubation of 4.5 (interquartile range 2.5 to 6.5) days. CSA progressively decreased from oral to lung end of used TTs. The luminal volume of air was different between used and new TTs for all internal diameters (P<0.01 for new vs. used TTs for all studied internal diameters). The relationship between pressure drop and increasing airflow rates was nonlinear and depended on minimum CSA available to ventilation. Weak correlation was found between TT occlusion and days of intubation (R²=0.352, P=0.006). With standard clinical chest CT scans, 6 of 20 TTs showed measurable secretions with a CSA reduction of 24.0±3.9%.

CONCLUSIONS

TT luminal narrowing is a common finding and correlates with increased airflow resistance. The authors propose high-resolution CT as a novel technique to visualize and quantify secretions collected within the TT lumen.

摘要

背景

气管插管会影响黏液清除功能，导致分泌物在气管导管（TT）内积聚。本研究旨在采用一种新方法评估危重症患者 TT 管腔阻塞情况。

方法

这是一项三阶段研究：（1）作者在拔管时收集了 20 个 TT。使用高分辨率计算机断层扫描（CT）确定 TT 内的横截面积（CSA）和黏液分布；（2）使用 5 个部分填充硅酮的 TT 来关联高分辨率 CT 结果和增加的气流阻力；（3）回顾 20 例插管患者的胸部 CT 扫描，以检测通气患者 TT 中的分泌物。

结果

拔管后的 TT 在中位插管时间为 4.5 天（四分位间距 2.5 至 6.5 天）后最大 CSA 减少（平均值±标准差）为 24.9±3.9%（范围 3.3 至 71.2%）。从口腔端到使用 TT 的肺端，CSA 逐渐减小。对于所有内径，使用 TT 和新 TT 的空气腔内体积均不同（所有研究内径的新 TT 与使用 TT 相比，P<0.01）。压降与气流增加率之间的关系是非线性的，取决于通气时可用的最小 CSA。TT 阻塞与插管天数之间的相关性较弱（R²=0.352，P=0.006）。使用标准临床胸部 CT 扫描，20 个 TT 中有 6 个显示可测量的分泌物，CSA 减少 24.0±3.9%。