Kako Hiromi, Alkhatib Omar, Krishna Senthil G, Khan Sarah, Naguib Aymen, Tobias Joseph D
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH, USA.
Paediatr Anaesth. 2015 Jul;25(7):705-10. doi: 10.1111/pan.12631. Epub 2015 Mar 4.
With the development of newer polyurethane cuffed endotracheal tubes (cETTs), there has been a shift in clinical practice among pediatric anesthesiologists. Despite improvements in design, excessive inflation of the cuff can still compromise tracheal mucosal perfusion. Several perioperative factors can affect the intracuff pressure (CP), and there is no consensus on safe CP in pediatric patients undergoing repair of congenital cardiac disease (CHD) utilizing cardiopulmonary bypass (CPB). In the current study, the CP was continuously monitored in pediatric patients undergoing surgery for CHD.
After IRB approval, this observational study was conducted on pediatric patients who underwent repair of CHD using CPB with a cETT in place. After anesthetic induction and endotracheal intubation, the cuff was inflated using the air leak technique while maintaining a continuous positive airway pressure of 20 cmH2 O. After inflation, the CP was continuously monitored throughout the procedure. In addition, temperature and mean arterial pressure (MAP) were also recorded.
The study included 33 patients who ranged in age from 1 month to 15.3 years. Their weight ranged from 4.0 to 83.6 kg. Six patients were excluded from the analysis due to the need to add or remove air from the cuff, leaving 27 patients for data analysis for cuff pressure over time. The baseline CP at the time of inflation was 16.1 ± 7.6 cmH2 O. With the use of CPB and initiation of hypothermia, when compared to the baseline, the CP decreased by -0.7 ± 5.8 cmH2 O at 35-37°C, -9.1 ± 8.4 cmH2 O at 31-33°C, -7.8 ± 6.2 cmH2 O at 27-29°C, and -11.1 ± 6.0 cmH2 O at <27°C. With rewarming, the CP increased back to the baseline level (-3.5 ± 7.0 cmH2 O).
There was a significant decrease in the CP during CPB and associated hypothermia. This may offer some protection for mucosal perfusion during CPB which is usually associated with lower than normal MAP. However, the decrease in the CP may compromise the tracheal seal which may not offer the intended protection for the airway from aspiration.
随着新型聚氨酯带套囊气管内导管（cETT）的发展，儿科麻醉医生的临床实践发生了变化。尽管设计有所改进，但套囊过度充气仍会损害气管黏膜灌注。围手术期的几个因素会影响套囊内压力（CP），对于接受先天性心脏病（CHD）修复术并使用体外循环（CPB）的儿科患者，安全的CP值尚无共识。在本研究中，对接受CHD手术的儿科患者的CP进行了连续监测。
经机构审查委员会（IRB）批准后，对使用带cETT的CPB进行CHD修复术的儿科患者进行了这项观察性研究。麻醉诱导和气管插管后，采用漏气技术使套囊充气，同时维持20 cmH₂O的持续气道正压。充气后，在整个手术过程中持续监测CP。此外，还记录了体温和平均动脉压（MAP）。
该研究纳入了33例年龄在1个月至15.3岁之间的患者。他们的体重在4.0至83.6 kg之间。6例患者因需要对套囊添加或抽出空气而被排除在分析之外，剩下27例患者用于分析套囊压力随时间的变化。充气时的基线CP为16.1±7.6 cmH₂O。在使用CPB并开始降温时，与基线相比，在35 - 37°C时CP下降了-0.7±5.8 cmH₂O，在31 - 33°C时下降了-9.1±8.4 cmH₂O，在27 - 29°C时下降了-7.8±6.2 cmH₂O，在<27°C时下降了-11.1±6.0 cmH₂O。复温时，CP回升至基线水平（-3.5±7.0 cmH₂O）。
CPB及相关低温期间CP显著降低。这可能为CPB期间的黏膜灌注提供一定保护，CPB通常与低于正常的MAP相关。然而，CP的降低可能会损害气管密封，可能无法为气道提供预期的防止误吸的保护。
