Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, Australia.
School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia.
Anaesthesia. 2018 Feb;73(2):160-168. doi: 10.1111/anae.14113. Epub 2017 Nov 23.
Cuffed tracheal tubes are increasingly used in paediatric anaesthetic practice. This study compared tidal volume and leakage around cuffed and uncuffed tracheal tubes in children who required standardised mechanical ventilation of their lungs in the operating theatre. Children (0-16 years) undergoing elective surgery requiring tracheal intubation were randomly assigned to receive either a cuffed or an uncuffed tracheal tube. Assessments were made at five different time-points: during volume-controlled ventilation 6 ml.kg , PEEP 5 cmH O and during pressure-controlled ventilation 10 cmH O / PEEP 5 cmH O. The pressure-controlled ventilation measurement time-points were: just before a standardised recruitment manoeuvre; just after recruitment manoeuvre; 10 min; and 30 min after the recruitment manoeuvre. Problems and complications were recorded. During volume-controlled ventilation, leakage was significantly less with cuffed tracheal tubes than with uncuffed tracheal tubes; in ml.kg , median (IQR [range]) 0.20 (0.13-0.39 [0.04-0.60]) vs. 0.82 (0.58-1.38 [0.24-4.85]), respectively, p < 0.001. With pressure-controlled ventilation, leakage was less with cuffed tracheal tubes and stayed unchanged over a 30-min period, whereas with uncuffed tracheal tubes, leakage was higher and increased further over the 30-min period. Tidal volumes were higher in the cuffed group and increased over time, but in the uncuffed group were lower and decreased over time. Both groups showed an increase in tidal volumes following recruitment manoeuvres. There were more short-term complications with uncuffed tracheal tubes, but no major complications were recorded in either group at long-term follow-up. With standardised ventilator settings, cuffed tracheal tubes produced better ventilation characteristics compared with uncuffed tracheal tubes during general anaesthesia for routine elective surgery.
套囊气管导管在小儿麻醉实践中越来越多地被使用。本研究比较了在手术室中需要对肺进行标准化机械通气的儿童中，带套囊和不带套囊的气管导管的潮气量和泄漏情况。接受择期手术且需要气管插管的儿童被随机分配接受带套囊或不带套囊的气管导管。评估在五个不同的时间点进行：在容量控制通气 6 ml.kg 时，PEEP 为 5 cmH 2 O 时，以及在压力控制通气 10 cmH 2 O / PEEP 为 5 cmH 2 O 时。压力控制通气的测量时间点为：在标准化复张手法之前；复张手法后；10 分钟；复张手法后 30 分钟。记录问题和并发症。在容量控制通气时，带套囊的气管导管的泄漏明显少于不带套囊的气管导管；以毫升/千克计，中位数（IQR [范围]）分别为 0.20（0.13-0.39 [0.04-0.60]）和 0.82（0.58-1.38 [0.24-4.85]），p < 0.001。在压力控制通气时，带套囊的气管导管的泄漏较少且在 30 分钟内保持不变，而不带套囊的气管导管的泄漏较高且在 30 分钟内进一步增加。带套囊组的潮气量较高且随时间增加，而不带套囊组的潮气量较低且随时间减少。两组在复张手法后均表现出潮气量增加。带套囊气管导管的短期并发症更多，但在长期随访中，两组均未记录到严重并发症。在标准化呼吸机设置下，与不带套囊的气管导管相比，带套囊的气管导管在常规择期手术全身麻醉期间产生了更好的通气特性。
