de Wit Michel, Peelen Linda M, van Wolfswinkel Leo, de Graaff Jurgen C
Department of Anesthesia, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
Paediatr Anaesth. 2018 Mar;28(3):210-217. doi: 10.1111/pan.13340.
The use of cuffed vs uncuffed endotracheal tubes in pediatric anesthesia is widely debated. This study aimed to investigate whether the use of cuffed vs uncuffed tubes is associated with an increased incidence of acute postoperative respiratory complications.
We retrospectively studied all children aged 0-7 years in which the trachea was intubated between September 28, 2006 and August 26, 2016 in a pediatric university hospital. Logistic regression analysis was performed to estimate the association between tube design (cuffed vs uncuffed) and the incidence of acute postoperative respiratory complications (stridor, wheezing, or dyspnea; desaturations ≤90%) in need of intervention (epinephrine, dexamethasone, nebulizers, supplementary oxygen, or reintubation), adjusting for potential confounders.
In 5247 of 6796 cases (77%), a cuffed tube was used. Acute postoperative respiratory complications in need of intervention occurred in 334 cases (4.9%) and were less common after cuffed than after uncuffed tubes (N = 236, 4.5% vs N = 98, 6.3%, respectively, odds ratio 0.70; 95%CI 0.55-0.89). Desaturation occurred less often after cuffed tubes (cuffed: N = 1365, 26.0%; uncuffed: N = 512, 33.1%; OR: 0.71 (0.61-0.84)). After adjusting for confounders, there was no difference in acute postoperative respiratory complications between cuffed tubes and uncuffed tubes (OR 0.74; 95%CI 0.55-1.01). Subgroup analyses in various age groups did not show significant differences between the use of cuffed or uncuffed tubes.
After adjustment for multiple confounders, the use of cuffed tubes was not associated with an increased incidence of acute respiratory complications in postanesthesia care unit.
在小儿麻醉中使用带套囊与不带套囊的气管内导管存在广泛争议。本研究旨在调查使用带套囊与不带套囊的导管是否与术后急性呼吸并发症的发生率增加相关。
我们回顾性研究了2006年9月28日至2016年8月26日期间在一家儿科大学医院接受气管插管的所有0至7岁儿童。进行逻辑回归分析以评估导管设计（带套囊与不带套囊）与需要干预（肾上腺素、地塞米松、雾化器、补充氧气或重新插管）的术后急性呼吸并发症（喘鸣、喘息或呼吸困难；血氧饱和度≤90%）发生率之间的关联，并对潜在混杂因素进行校正。
6796例病例中有5247例（77%）使用了带套囊导管。需要干预的术后急性呼吸并发症发生在334例（4.9%），带套囊导管后的发生率低于不带套囊导管（分别为N = 236，4.5% 与N = 98，6.3%，比值比0.70；95%置信区间0.55 - 0.89）。带套囊导管后血氧饱和度下降的情况较少见（带套囊：N = 1365，26.0%；不带套囊：N = 512，33.1%；比值比：0.71（0.61 - 0.84））。校正混杂因素后，带套囊导管与不带套囊导管在术后急性呼吸并发症方面无差异（比值比0.74；95%置信区间0.55 - 1.01）。各年龄组的亚组分析未显示使用带套囊或不带套囊导管之间存在显著差异。
在对多个混杂因素进行校正后，在麻醉后护理单元中使用带套囊导管与急性呼吸并发症的发生率增加无关。
