Vallés Jordi, Millán Susana, Díaz Emili, Castanyer Eva, Gallardo Xavier, Martín-Loeches Ignacio, Andreu Marta, Prenafeta Mario, Saludes Paula, Lema Jorge, Batlle Montse, Bacelar Néstor, Artigas Antoni
Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain.
Universitat Autonoma Barcelona, Sabadell, Spain.
Ann Intensive Care. 2017 Nov 2;7(1):109. doi: 10.1186/s13613-017-0331-0.
Continuous aspiration of subglottic secretions is effective in preventing ventilator-associated pneumonia, but it involves a risk of mucosal damage. The main objective of our study was to determine the incidence of airway complications related to continuous aspiration of subglottic secretions.
In consecutive adult patients with continuous aspiration of subglottic secretions, we prospectively recorded clinical airway complications during the period after extubation. A multidetector computed tomography of the neck was performed during the period of 5 days following extubation to classify subglottic and tracheal lesions as mucosal thickening, cartilage thickening or deep ulceration.
In the 86 patients included in the study, 6 (6.9%) had transient dyspnea, 7 (8.1%) had upper airway obstruction and 18 (20.9%) had dysphonia at extubation. Univariate analysis identified more attempts required for intubation (2.3 ± 1.1 vs. 1.2 ± 0.5; p = 0.001), difficult intubation (71.4 vs. 10.1%, p = 0.001) and Cormack score III-IV (71.4 vs. 8.8%; p < 0.001) as risk factors for having an upper airway obstruction at extubation. The incidence of failed extubation among patients after planned extubation was 18.9% and 11 patients (12.7%) required tracheostomy. A multidetector computed tomography was performed in 37 patients following extubation, and injuries were observed in 9 patients (24.3%) and classified as tracheal injuries in 2 patients (1 cartilage thickening and 1 mild stenosis with cartilage thickening) and as subglottic mucosal thickenings in 7 patients.
The incidence of upper airway obstruction after extubation in patients with continuous aspiration of subglottic secretions was 8.1%, and the injuries observed by computed tomography were not severe and located mostly in subglottic space.
持续吸引声门下分泌物对预防呼吸机相关性肺炎有效，但存在黏膜损伤风险。本研究的主要目的是确定与持续吸引声门下分泌物相关的气道并发症发生率。
在连续接受持续声门下分泌物吸引的成年患者中，我们前瞻性记录了拔管后期间的临床气道并发症。在拔管后5天内进行颈部多排螺旋计算机断层扫描，将声门下和气管病变分类为黏膜增厚、软骨增厚或深度溃疡。
在纳入研究的86例患者中，6例（6.9%）出现短暂性呼吸困难，7例（8.1%）出现上气道梗阻，18例（20.9%）在拔管时出现声音嘶哑。单因素分析确定插管所需尝试次数更多（2.3±1.1比1.2±0.5；p=0.001）、插管困难（71.4%比10.1%，p=0.001）和Cormack评分III-IV级（71.4%比8.8%；p<0.001）是拔管时发生上气道梗阻的危险因素。计划拔管后患者的拔管失败发生率为18.9%，11例患者（12.7%）需要气管切开术。37例患者在拔管后进行了多排螺旋计算机断层扫描，9例患者（24.3%）观察到损伤，其中2例患者（1例软骨增厚和1例伴有软骨增厚的轻度狭窄）被分类为气管损伤，7例患者被分类为声门下黏膜增厚。
持续吸引声门下分泌物患者拔管后上气道梗阻的发生率为8.1%，计算机断层扫描观察到的损伤并不严重，主要位于声门下间隙。
