Annoni Raquel, Pires-Neto Ruy Camargo
Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Rev Bras Ter Intensiva. 2014 Oct-Dec;26(4):367-72. doi: 10.5935/0103-507X.20140056.
To test the effectiveness of using a cuff pressure relief valve technique to maintain cuff pressure levels within the normal in vitro range (Phase 1) in patients admitted to the intensive care unit (Phase 2) and to test the reproducibility of the technique using different syringes.
In Phase 1, a tracheal tube was inserted into a trachea model. Ten- and 20mL syringes were used to inflate the cuff through the tracheal tube. The cuff was slowly and steadily inflated until the syringe plunger would move in the opposite direction of the application. After the plunger stopped, the cuff pressures were recorded. In Phase 2, the same maneuvers for inflating the cuff were performed on 20 patients using 5, 10, and 20mL syringes and were compared with manometer measurements. The intraclass correlation coefficient and Bland-Altman analysis were employed to determine the reproducibility and agreement between syringes. Data were expressed as medians (interquartile range).
There was no reproducibility between syringes with an intraclass correlation coefficient ranging between -0.33 and 0.8 (p>0.05). The pressures generated with the syringes were higher than the pressures generated using a standard manometer: the 5mL syringe pressure was 105cmH2O (82.5-120cmH2O), the 10mL syringe pressure was 69cmH2O (47.5-111.3cmH2O), and the 20mL syringe pressure was 45cmH2O (35-59.5cmH2O). The Bland-Altman analysis confirmed the large bias and variability between the syringes used, compared with the manometer.
The use of syringes is not an effective technique for determining the cuff pressure in patients admitted to the intensive care unit.
测试使用袖带压力释放阀技术将袖带压力维持在体外正常范围内（第一阶段）对重症监护病房患者（第二阶段）的有效性，并测试该技术使用不同注射器时的可重复性。
在第一阶段，将气管导管插入气管模型。使用10毫升和20毫升注射器通过气管导管给袖带充气。袖带缓慢稳定地充气，直到注射器活塞向施加方向的相反方向移动。活塞停止后，记录袖带压力。在第二阶段，对20名患者使用5毫升、10毫升和20毫升注射器进行相同的袖带充气操作，并与压力计测量结果进行比较。采用组内相关系数和布兰德-奥特曼分析来确定注射器之间的可重复性和一致性。数据以中位数（四分位间距）表示。
注射器之间不存在可重复性，组内相关系数在-0.33至0.8之间（p>0.05）。注射器产生的压力高于使用标准压力计产生的压力：5毫升注射器压力为105cmH₂O（82.5 - 120cmH₂O），10毫升注射器压力为69cmH₂O（47.5 - 111.3cmH₂O），20毫升注射器压力为45cmH₂O（35 - 59.5cmH₂O）。布兰德-奥特曼分析证实，与压力计相比，所用注射器之间存在较大偏差和变异性。
对于重症监护病房的患者，使用注射器并非确定袖带压力的有效技术。
