Komasawa Nobuyasu, Fujiwara Shunsuke, Miyazaki Shinichiro, Ohchi Fumihiro, Minami Toshiaki
Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
J Emerg Med. 2015 Feb;48(2):241-6. doi: 10.1016/j.jemermed.2014.06.064. Epub 2014 Oct 29.
Endotracheal tube placement during resuscitation is important for definite tracheal protection. Accidental extubation due to endotracheal tube displacement is a rare event that can result in severe complications.
This study evaluated how endotracheal tube displacement is affected by tape vs. tube holder fixation using a manikin and auto-chest compression machine simulation.
The endotracheal tube was placed in either a shallow or a deep position, with the tube cuff at the center of the glottis or 26 cm from the incisors in an advanced lifesaving simulator. Trials were performed five times in each setting with: no fixation; Durapore® tape fixation; Multipore® tape fixation; and Thomas tube holder® fixation. After 10 min of automated chest compressions, endotracheal tube shift was measured. Statistical analysis was performed with one-way repeated analysis of variance or χ(2) test, with p < 0.05 considered significant.
In the shallow setting, endotracheal tube extubation occurred in all trials with no fixation, Durapore, and Multipore. In contrast, no extubation occurred in the Tube holder trials (p < 0.05). In the deep setting, no extubation was confirmed in any trial. Relative to no fixation (0.56 ± 0.11 cm), endotracheal tube shift was significantly less in the Durapore tape, Multipore tape, and Tube holder groups (p < 0.05). Of the three fixation methods, Tube holder (0.04 ± 0.05 cm) showed significantly less shift (p < 0.05) relative to Durapore (0.28 ± 0.04 cm) and Multipore (0.32 ± 0.08 cm).
Endotracheal tube displacement occurs less with Tube holder fixation than with Durapore tape or Multipore tape during simulation of continuous chest compressions.
复苏期间气管内插管对于明确的气管保护很重要。气管内导管移位导致的意外拔管是一种罕见事件，可能会导致严重并发症。
本研究使用人体模型和自动胸外按压机模拟评估胶带与管夹固定对气管内导管移位的影响。
在高级生命支持模拟器中，将气管内导管置于浅位或深位，使管套囊位于声门中心或距门齿26厘米处。在每种设置下进行五次试验，分别为：不固定；使用杜拉普尔胶带固定；使用多孔胶带固定；以及使用托马斯管夹固定。在自动胸外按压10分钟后，测量气管内导管的移位情况。采用单向重复方差分析或χ²检验进行统计分析，p<0.05认为具有显著性。
在浅位设置中，不固定、使用杜拉普尔胶带和多孔胶带的所有试验均发生了气管内导管拔管。相比之下，管夹试验中未发生拔管（p<0.05）。在深位设置中，任何试验均未确认发生拔管。相对于不固定（0.56±0.11厘米），杜拉普尔胶带、多孔胶带和管夹组的气管内导管移位明显更少（p<0.05）。在三种固定方法中，管夹（0.04±0.05厘米）相对于杜拉普尔胶带（0.28±0.04厘米）和多孔胶带（0.32±0.08厘米）显示出明显更少的移位（p<0.05）。
在连续胸外按压模拟过程中，管夹固定比杜拉普尔胶带或多孔胶带固定导致的气管内导管移位更少。
