机械通气危重症患者体位对气管内套囊压力的影响。

Effect of patient position on endotracheal cuff pressure in mechanically ventilated critically ill patients.

机构信息

Surgical Nursing Department, Ege University Faculty of Nursing, Turkey.

出版信息

Aust Crit Care. 2017 Sep;30(5):267-272. doi: 10.1016/j.aucc.2016.11.006. Epub 2016 Dec 16.

DOI:10.1016/j.aucc.2016.11.006

PMID:27993545

Abstract

BACKGROUND

Endotracheal tube cuff pressure must be maintained within 20-30mHO to prevent complications. There is limited literature reporting the impact of nursing care on endotracheal cuff pressure. However, few studies have reported the effect of nursing care on endotracheal cuff pressure.

OBJECTIVES

This study was performed to investigate the effects of body position on endotracheal cuff pressure.

METHODS

Twenty-five patients receiving mechanical ventilatory therapy were placed in a baseline position (semirecumbent position with the head of the bed elevated at 30° and head in a neutral position) with endotracheal tube cuff was adjusted to 25cmHO. The patients were moved into 16 different positions: anteflexion of the head; hyperextension of the head; left lateral flexion of the head; right lateral flexion of the head; rotation of the head to the left; rotation of the head to the right; semirecumbent position with 45° elevation of the head of the bed; recumbent position with 10° elevation of the head of the bed; supine position; trendelenburg position 10°; left lateral position at 30°, 45°, and 90°; and right lateral position at 30°, 45°, and 90°. The endotracheal tube cuff pressure was measured and recorded after each position change.

RESULTS

Among the 400 endotracheal tube cuff pressure measurements (25 patients×16 positions) 10 (2.5%) were lower than 20cmHO; 201 (50.3%) were between 20-30cmHO and 189 (47.3%) were higher than 30cmHO. Mean endotracheal tube cuff pressure increased from 25 to 32.59±4.08cmHO after changing the patients' position. Friedman test indicated a statistically significant deviation in the ETCP across the 16 positions (X2: 122.019, p: 0.0001).

CONCLUSIONS

Body positioning during daily nursing care effected the endotracheal tube cuff pressure, suggesting that endotracheal tube cuff pressure should be measured after changing a patient's position and adjusted within the recommended range.

摘要

背景

为了防止并发症，气管导管套囊压力必须保持在 20-30mmHg 之间。有有限的文献报道护理对气管导管套囊压力的影响。然而，很少有研究报道护理对气管导管套囊压力的影响。

目的

本研究旨在探讨体位对气管导管套囊压力的影响。

方法

将 25 例接受机械通气治疗的患者置于基线体位（床头抬高 30°，头中立位的半卧位），将气管导管套囊调整至 25cmHO。患者被移动到 16 个不同的位置：头前屈；头过度伸展；头左侧侧屈；头右侧侧屈；头向左侧旋转；头向右侧旋转；床头抬高 45°的半卧位；床头抬高 10°的仰卧位；仰卧位；头高位 10°的斜坡位；左侧卧位 30°、45°和 90°；右侧卧位 30°、45°和 90°。每个位置改变后测量并记录气管导管套囊压力。

结果

在 400 次气管导管套囊压力测量中（25 例患者×16 个位置），10 次（2.5%）低于 20cmHO；201 次（50.3%）在 20-30cmHO 之间；189 次（47.3%）高于 30cmHO。患者体位改变后，气管导管套囊压力从 25cmHO 平均增加到 32.59±4.08cmHO。Friedman 检验表明，在 16 个位置上，ETCP 存在统计学上的显著偏差（X2：122.019，p：0.0001）。