Nishioka Hiroko, Usuda Yutaka, Hirabayashi Go, Maruyama Koichi, Andoh Tomio
Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, 213-8507, Japan.
Department of Anesthesiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama, 350-1298, Japan.
BMC Anesthesiol. 2017 Sep 19;17(1):129. doi: 10.1186/s12871-017-0416-1.
Lubrication of cuffed tracheal tubes (CTTs) reduces liquid leakage. However, it is not clear how cuff lubrication influences air leakage. We aimed to test the hypothesis that pretreatment with K-Y jelly, a water-soluble lubricant, would improve the air-sealing performance of pediatric CTTs in a model study.
We placed Parker Flex-Tip™ CTT with 4.0- and 5.0-mm internal diameter (ID) into a tracheal model with 9- and 12-mm ID. The tracheal model was connected to a test lung ventilated in pressure control mode. We compared three cuff lubrication conditions: none (N), water (W), and K-Y jelly (KY). We measured the leak airway pressure (LAWP), defined as the lowest peak airway pressure (PAWP) at which leakage was detected, with the fixed cuff pressure (CP) at 20 cmHO and varied PAWP. We also measured the leak CP (LCP), defined as the highest CP at which leakage was detected, with fixed PAWP at 25 cmHO and varied CP. We confirmed air leakage when an apparent elevation of oxygen concentration was detected above the cuff after changing the inspiratory gas from air to oxygen.
For both 4.0-mm ID and 5.0-mm ID endotracheal tubes, the KY group showed significantly higher LAWP and lower LCP than the other two groups. For the 4.0-mm ID, median values and ranges of LAWP and LCP were K-Y group: 25 (25) and 15 (15); N group: 5 (5) and 35 (35): and W group: 5 (5) and 35 (15-35) cmHO. For the 5.0-mm ID, median values and ranges of LAWP and LCP were K-Y group: 25 (15-25) and 15 (15-35); N group: 5 (5) and 35 (35); and W group: 5 (5) and 35 (15-35) cmHO. Water application did not change these outcomes compared with the N group.
Pre-treatment of the cuff with K-Y jelly significantly improved the air-sealing performance of a pediatric CTT in our model study.
带套囊气管导管（CTT）的润滑可减少液体泄漏。然而，套囊润滑如何影响空气泄漏尚不清楚。我们旨在通过一项模型研究验证以下假设：使用水溶性润滑剂K-Y胶进行预处理可改善小儿CTT的气密性能。
我们将内径为4.0和5.0毫米的派克Flex-Tip™ CTT放入内径为9和12毫米的气管模型中。气管模型连接到以压力控制模式通气的测试肺。我们比较了三种套囊润滑情况：无（N）、水（W）和K-Y胶（KY）。我们测量了泄漏气道压力（LAWP），其定义为在固定套囊压力（CP）为20 cmH₂O且气道峰压（PAWP）变化时检测到泄漏的最低PAWP。我们还测量了泄漏CP（LCP），其定义为在固定PAWP为25 cmH₂O且CP变化时检测到泄漏的最高CP。当吸气气体从空气改为氧气后，在套囊上方检测到氧浓度明显升高时，我们确认存在空气泄漏。
对于内径4.0毫米和5.0毫米的气管导管，KY组的LAWP显著高于其他两组，LCP则显著低于其他两组。对于内径4.0毫米的导管，LAWP和LCP的中位数及范围为：KY组：25（25）和15（15）；N组：5（5）和35（35）；W组：5（5）和35（15 - 35）cmH₂O。对于内径5.0毫米的导管，LAWP和LCP的中位数及范围为：KY组：25（15 - 25）和15（15 - 35）；N组：5（5）和35（35）；W组：5（5）和35（15 - 35）cmH₂O。与N组相比，用水处理并未改变这些结果。
在我们的模型研究中，用K-Y胶对套囊进行预处理可显著改善小儿CTT的气密性能。
