Kim Tae Kyong, Min Jeong Jin, Seo Jeong-Hwa, Lee Yong-Hun, Ju Jae-Woo, Bahk Jae-Hyon, Hong Deok Man, Jeon Yunseok
From the Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital (TKK, J-HS, Y-HL, J-WJ, J-HB, DMH, YJ), and Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Seoul, Korea (JJM).
Eur J Anaesthesiol. 2015 Aug;32(8):549-54. doi: 10.1097/EJA.0000000000000204.
Excessive tracheal cuff pressure reduces tracheal mucosal blood flow and increases tracheal morbidity. Inserting a transoesophageal echocardiography (TOE) probe has been shown to increase tracheal cuff pressure.
To evaluate the effect of inserting a TOE probe on tracheal cuff pressure and compare the effect in patients who received a single-lumen endotracheal tube (SLT) with those who received a double-lumen endotracheal tube (DLT).
A prospective, observational study.
Single-centre trial, study period from October 2013 to January 2014.
Forty-four adult patients scheduled for elective cardiothoracic surgery requiring intraoperative TOE monitoring.
After tracheal intubation with a SLT (n = 22) or DLT (n = 22), the tracheal cuff was inflated to 18 mmHg (25 cmH2O) with air. Tracheal cuff pressure was monitored continuously for 5 min after inserting the TOE probe.
The primary endpoint was steady-state tracheal cuff pressure after insertion of the TOE probe.
Median (interquartile range, IQR) tracheal cuff pressure stabilised at 3 (2 to 3) min in the SLT group and at 2 (1 to 3) min in the DLT group. Steady-state cuff pressure was significantly higher in the DLT group than that in the SLT group [36.7 (31.3 to 44.1) vs. 31.3 (29.6 to 35.7) cmH2O; (P = 0.03)]. Steady-state cuff pressure more than 40 cmH2O was observed in two patients (18.2%) in the SLT group and nine patients (40.9%) in the DLT group (P = 0.02).
Insertion of a TOE probe increased tracheal cuff pressure in both the SLT and DLT groups. The increase in cuff pressure was greater in patients who received a DLT. Frequent measurement and adjustment of cuff pressure should be emphasised particularly when TOE is used in patients receiving a DLT.
Clinicaltrials.gov identifier: NCT02034643.
气管导管套囊压力过高会减少气管黏膜血流并增加气管发病风险。已证实插入经食管超声心动图（TOE）探头会增加气管导管套囊压力。
评估插入TOE探头对气管导管套囊压力的影响，并比较接受单腔气管插管（SLT）患者与接受双腔气管插管（DLT）患者的影响。
一项前瞻性观察性研究。
单中心试验，研究期为2013年10月至2014年1月。
44例计划接受择期心胸外科手术且术中需要TOE监测的成年患者。
使用SLT（n = 22）或DLT（n = 22）进行气管插管后，用空气将气管导管套囊充气至18 mmHg（25 cmH₂O）。插入TOE探头后连续监测气管导管套囊压力5分钟。
主要终点是插入TOE探头后的稳态气管导管套囊压力。
SLT组气管导管套囊压力在3（2至3）分钟时稳定，DLT组在2（1至3）分钟时稳定。DLT组的稳态套囊压力显著高于SLT组[36.7（31.3至44.1）对31.3（29.6至35.7）cmH₂O；（P = 0.03）]。SLT组有2例患者（18.2%）、DLT组有9例患者（40.9%）观察到稳态套囊压力超过40 cmH₂O（P = 0.02）。
插入TOE探头会使SLT组和DLT组的气管导管套囊压力均升高。接受DLT的患者套囊压力升高幅度更大。尤其在接受DLT的患者中使用TOE时，应强调频繁测量和调整套囊压力。
Clinicaltrials.gov标识符：NCT02034643。
