Mahdavi Alireza, Razavi Seyed Sajad, Malekianzadeh Bita, Sadeghi Afsaneh
Department of Pediatric Anesthesia, Shahid Beheshti University of Medical Science, Tehran, Iran.
Tanaffos. 2017 Jun;16(4):289-294.
The present study was performed with the aim of comparing the peak inspiratory pressure and lung dynamic compliance between a classic laryngeal mask airway (LMA) and an endotracheal tube in children under mechanical ventilation.
In this study, 30 children aged 1 to 7 years with a physical condition of ASA I-II who were admitted for operations to repair inguinal hernias, hydroceles, or hypospadias were randomly enrolled. After induction of anesthesia, the appropriate laryngeal mask was used for each patient and they were placed under pressure-controlled mechanical ventilation. The peak inspiratory pressure was adjusted and recorded to obtain an appropriate tidal volume, then the laryngeal mask was removed and the appropriate size uncuffed endotracheal tube was inserted and the patient was placed again under controlled mechanical ventilation. The required settings were adjusted and peak inspiratory pressure and tidal volume were measured and recorded by the ventilator. Dynamic compliance was also calculated in both cases using the appropriate formula.
The results showed that peak inspiratory pressure (PIP) with the use of LMA in children under mechanical ventilation was less than the PIP with the use of an endotracheal tube (p<0.05). Also, the pulmonary dynamic compliance with a laryngeal mask was greater than the use of an endotracheal tube (p<0.05).
A laryngeal mask airway due to its low airway resistance and high dynamic compliance is an acceptable alternative to a tracheal tube during mechanical ventilation and it can be a good alternative to the endotracheal tube, especially during mechanical ventilation of children, in whom avoidance of barotrauma is desirable.
本研究旨在比较经典喉罩气道(LMA)与气管插管在机械通气儿童中的吸气峰压和肺动态顺应性。
本研究随机纳入30例年龄1至7岁、美国麻醉医师协会(ASA)身体状况分级为I-II级、因腹股沟疝、鞘膜积液或尿道下裂修补手术入院的儿童。麻醉诱导后,为每位患者使用合适的喉罩,并将其置于压力控制的机械通气下。调整并记录吸气峰压以获得合适的潮气量,然后移除喉罩,插入合适尺寸的无套囊气管插管,并再次将患者置于控制机械通气下。调整所需设置,呼吸机测量并记录吸气峰压和潮气量。两种情况下均使用合适公式计算动态顺应性。
结果显示,机械通气儿童使用LMA时的吸气峰压(PIP)低于使用气管插管时的PIP(p<0.05)。此外,使用喉罩时的肺动态顺应性大于使用气管插管时的肺动态顺应性(p<0.05)。
喉罩气道因其气道阻力低和动态顺应性高,在机械通气期间是气管导管的可接受替代方案,尤其是在儿童机械通气期间,此时避免气压伤是可取的,它可以成为气管插管的良好替代方案。