Dayan Amir C, Epstein Richard H
From the *Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and †Department of Anesthesiology, Pain Management, and Perioperative Medicine, University of Miami, Miller School of Medicine, Miami, Florida.
Anesth Analg. 2016 Nov;123(5):1158-1162. doi: 10.1213/ANE.0000000000001552.
An intact pilot balloon assembly is crucial to the proper function of a cuffed tracheal tube. Disruption of the pilot balloon, transection of the inflation line, or valve incompetence results in cuff deflation, which may lead to inadequate ventilation and aspiration of secretions. Such failures typically result in tracheal tube replacement, but this may be a safety risk if a difficult reintubation is anticipated. We recently encountered such a patient who remained intubated postoperatively and in whom the inflation line was transected, causing a large leak. We describe a method to reconstitute the inflation line and report on the structural integrity of the repair. We hypothesized that the repaired assembly would maintain cuff pressure not statistically different from an intact device, but that the inflation line would be weaker.
The distal (tapered) portion of a 22-gauge intravenous (IV) catheter was partially inserted into the severed end of the inflation line. A new pilot balloon was cut from an intact tracheal tube with the tubing attached, the end of which had been dilated using a 22-gauge IV catheter. The new tubing was then guided over the protruding portion of the catheter, creating an internal stent. We measured the drop in cuff pressure after 8 hours in an artificial trachea for repaired and intact tracheal tubes. We tested the integrity of the repaired segments, underwater, to high-pressure inflation. We measured the static tensile strength of the inflation line from intact and repaired tracheal tubes. Data are presented as the mean ± standard error. Differences were assessed using the unpaired, 2-sided Student t test, with P < .05 required to claim statistical significance.
Eight-hour interval measurements in 10 intact versus 10 repaired tracheal tubes demonstrated no significant difference in pressure drop (mean difference = 0.5 cm H2O; 95% confidence interval, -2.2 to 1.2 cm H2O; P = .54). There was no visible air leak from 10 repaired inflation line segments when the cuff was inflated to 120 mm Hg. The force needed to break the repaired inflation line was lower than for the intact tubing (n = 7 of each; mean difference = -21.9 N; 95% confidence interval, -25.7 to -18.1 N; P < 10). Repairs to tracheal tubes from various manufacturers with inner diameters ranging from 3.0 to 8.0 mm were successful.
Repairing a disrupted pilot balloon assembly using an IV catheter as a stent inside the inflation line is an effective temporizing measure in situations where ventilation is impaired and where tracheal tube replacement may present an excessive patient risk.
完整的指示球囊组件对于带套囊气管导管的正常功能至关重要。指示球囊破裂、充气管横断或阀门功能不全可导致套囊放气，这可能会导致通气不足和分泌物误吸。此类故障通常需要更换气管导管，但如果预计再次插管困难，这可能会带来安全风险。我们最近遇到一名患者，术后仍需插管，其充气管被横断，导致大量漏气。我们描述了一种重建充气管的方法，并报告了修复后的结构完整性。我们假设修复后的组件维持的套囊压力与完整装置在统计学上无差异，但充气管会更脆弱。
将一根22号静脉输液（IV）导管的远端（锥形部分）部分插入充气管的断端。从一根带有连接管的完整气管导管上剪下一个新的指示球囊，其末端已用22号IV导管扩张。然后将新的连接管套在导管的突出部分上，形成一个内部支架。我们在人工气管中测量了修复后的气管导管和完整气管导管在8小时后的套囊压力下降情况。我们在水下对修复后的部分进行高压充气测试其完整性。我们测量了完整气管导管和修复后气管导管充气管的静态拉伸强度。数据以平均值±标准误差表示。使用未配对的双侧Student t检验评估差异，要求P <.05才有统计学意义。
对10根完整气管导管和10根修复后的气管导管进行8小时间隔测量，结果显示压力下降无显著差异（平均差异 = 0.5 cm H2O；95%置信区间，-2.2至1.2 cm H2O；P =.54）。当套囊充气至120 mmHg时，10个修复后的充气管段没有可见的漏气。破坏修复后的充气管所需的力低于完整的连接管（每组n = 7；平均差异 = -21.9 N；95%置信区间，-25.7至-18.1 N；P < 0.001）。对不同制造商内径从3.0至8.0 mm的气管导管进行修复均获成功。
在通气受损且气管导管更换可能给患者带来过高风险的情况下，使用IV导管作为充气管内的支架修复破裂的指示球囊组件是一种有效的临时措施。
