Berlet Thomas, Marchon Mathias
Department of Intensive Care Medicine, Inselspital-Bern University Hospital, 3010 Bern, Switzerland.
Department of Anaesthesiology and Pain Therapy, Inselspital-Bern University Hospital, 3010 Bern, Switzerland.
Anesthesiol Res Pract. 2016;2016:9272865. doi: 10.1155/2016/9272865. Epub 2016 Mar 17.
This study compared the leakage characteristics of different types of dual-cannula fenestrated tracheostomy tubes during positive pressure ventilation. Fenestrated Portex® Blue Line Ultra®, TRACOE® twist, or Rüsch® Traceofix® tracheostomy tubes equipped with nonfenestrated inner cannulas were tested in a tracheostomy-lung simulator. Transfenestration pressures and transfenestration leakage rates were measured during positive pressure ventilation. The impact of different ventilation modes, airway pressures, temperatures, and simulated static lung compliance settings on leakage characteristics was assessed. We observed substantial differences in transfenestration pressures and transfenestration leakage rates. The leakage rates of the best performing tubes were <3.5% of the delivered minute volume. At body temperature, the leakage rates of these tracheostomy tubes were <1%. The tracheal tube design was the main factor that determined the leakage characteristics. Careful tracheostomy tube selection permits the use of fenestrated tracheostomy tubes in patients receiving positive pressure ventilation immediately after stoma formation and minimises the risk of complications caused by transfenestration gas leakage, for example, subcutaneous emphysema.
本研究比较了不同类型的双套管开窗气管造口术导管在正压通气期间的漏气特性。在气管造口-肺模拟器中测试了配备无开窗内套管的Portex® Blue Line Ultra®、TRACOE® twist或Rüsch® Traceofix®开窗气管造口术导管。在正压通气期间测量经开窗压力和经开窗漏气率。评估了不同通气模式、气道压力、温度和模拟静态肺顺应性设置对漏气特性的影响。我们观察到经开窗压力和经开窗漏气率存在显著差异。性能最佳的导管的漏气率低于输送分钟通气量的3.5%。在体温下，这些气管造口术导管的漏气率低于1%。气管导管设计是决定漏气特性的主要因素。仔细选择气管造口术导管可使在造口形成后立即接受正压通气的患者使用开窗气管造口术导管，并将经开窗气体泄漏引起的并发症风险降至最低，例如皮下气肿。
