Delorenzo Ashleigh J, Shepherd Matthew, Jennings Paul A
Air Med J. 2017 Mar-Apr;36(2):81-84. doi: 10.1016/j.amj.2017.01.003. Epub 2017 Mar 1.
Cuff pressures are important in ventilated patients undergoing helicopter transport. An altitude-related increase in endotracheal tube (ETT) intracuff pressure has been shown in simulated hypobaric environments, model tracheas, and animal studies and may not accurately reflect in vivo pressures. The aim of this study was to determine if ETT intracuff pressure increases above the critical perfusion pressure of the trachea in ventilated patients during helicopter transport.
Ovid Medline, CINAHL, Embase, Scopus, and the Cochrane Library were searched from their commencement to January 29, 2016. Google Scholar was searched, and reference lists of relevant articles were examined to identify additional studies. Articles were included if they reported on ETT intracuff pressure in ventilated patients during helicopter emergency medical service transport.
A total of 330 articles were identified; only 2 prospective observational studies met the inclusion criteria. The studies reported a mean cuff pressure increase of 23 cm HO and 33.9 cm HO. Both studies reported ETT intracuff pressure to frequently exceed the critical perfusion pressure of the tracheal mucosa during helicopter transport.
Further research with longitudinal follow-up is required to confirm these findings to determine if the effects of transient increased ETT intracuff pressure are clinically significant.
对于接受直升机转运的机械通气患者，气管导管套囊压力很重要。在模拟低压环境、模型气管及动物研究中，已证实气管内导管（ETT）套囊内压力会随海拔升高而增加，且可能无法准确反映体内压力。本研究旨在确定在直升机转运期间，机械通气患者的ETT套囊内压力是否会升高至超过气管的临界灌注压。
检索了Ovid Medline、CINAHL、Embase、Scopus和Cochrane图书馆，检索时间从建库至2016年1月29日。还检索了谷歌学术，并查阅了相关文章的参考文献列表以识别其他研究。如果文章报道了在直升机紧急医疗服务转运期间机械通气患者的ETT套囊内压力，则纳入研究。
共识别出330篇文章；仅有2项前瞻性观察性研究符合纳入标准。这些研究报告套囊压力平均升高23 cm HO和33.9 cm HO。两项研究均报告在直升机转运期间，ETT套囊内压力经常超过气管黏膜的临界灌注压。
需要进行进一步的纵向随访研究以证实这些发现，从而确定ETT套囊内压力短暂升高的影响在临床上是否具有显著意义。
