Basuni Ahmed Sobhy
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Tanta University, Egypt.
Saudi J Anaesth. 2014 Oct;8(4):451-5. doi: 10.4103/1658-354X.140816.
The objective of this study is to investigate the effect of intracuff alkalized lidocaine on sedative/analgesic requirements for mechanically ventilated patients and its consequence on patient-ventilator interaction.
A total of 64 patients who expected to require ventilatory support for a period of more than 48 h were randomly assigned to groups S and L. In group S, the endotracheal tube (ETT) cuffs were inflated with normal saline. In group L, the ETT cuffs were inflated with lidocaine 2% and sodium bicarbonate 8.4%. The investigator and the surgical intensive care unit staff were blinded to the nature of cuff-filled solutions. Sedation was maintained with propofol and fentanyl infusions. The total requirements for propofol and fentanyl, frequency and severity of cough and number of ineffective triggering during the first 24 h of mechanical ventilation were recorded.
There was a significant reduction (about 30%) in the requirements for propofol and fentanyl in patients who received intracuff alkalinized lidocaine; P < 0.001. The frequency and severity of cough were significantly lower in group L compared with group S and the frequency of ineffective triggering was significantly lower in group L; P < 0.001 for both comparisons.
Intracuff alkalized lidocaine increases ETT tolerance and hence, decreases sedatives/analgesics requirements for mechanically ventilated patients. This results in improved patient-ventilator synchronization.
本研究的目的是探讨气管导管套囊内碱化利多卡因对机械通气患者镇静/镇痛需求的影响及其对患者与呼吸机相互作用的影响。
总共64例预计需要机械通气支持超过48小时的患者被随机分为S组和L组。S组气管导管（ETT）套囊用生理盐水充盈。L组气管导管套囊用2%利多卡因和8.4%碳酸氢钠充盈。研究者和外科重症监护病房工作人员对套囊填充溶液的性质不知情。采用丙泊酚和芬太尼输注维持镇静。记录机械通气最初24小时内丙泊酚和芬太尼的总需求量、咳嗽的频率和严重程度以及无效触发次数。
接受套囊内碱化利多卡因的患者对丙泊酚和芬太尼的需求量显著降低（约30%）；P<0.001。与S组相比，L组咳嗽的频率和严重程度显著更低，且L组无效触发的频率显著更低；两组比较P均<0.001。
套囊内碱化利多卡因可提高气管导管耐受性，从而降低机械通气患者的镇静/镇痛需求。这可改善患者与呼吸机的同步性。
