Williams George W, Artime Carlos A, Mancillas Omar L, Syed Tariq A, Burnett Tyrone, Graham Russell, Tam Jason, Hagberg Carin A
Department of Anesthesiology and Neurosurgery, Division of Critical Care Medicine, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, Texas.
Department of Anesthesiology, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, Texas.
Clin Respir J. 2019 Jan;13(1):66-69. doi: 10.1111/crj.12984.
Risks of endotracheal tube cuff (ETTC) over inflation must be balanced with the need to achieve a minimum pressure of 20 cm H O. Methods have been developed to estimate adequate ETTC pressurization but do not provide accurate endotracheal tube cuff pressure (ETCP) measurements. Hence, different sized syringes may play a role in determining ETCP.
Determine optimal syringe size for recommended ETCP.
Two hundred patients were randomized to use of either a 10-mL syringe (standard syringe) or a 5-mL syringe (study group) for ETTC inflation. Following the insertion of the endotracheal tube, the ETTC was inflated per the attending anesthesiologist. Within 10 minutes of intubation, ETCP was measured with a hospital-provided manometer.
The percentage of in range cuff pressures for the 5-mL group was 10.53% and 6.78% for the 10-mL group. 84.21% (n = 64) of the study group and 91.53% (n = 54) of the control group had cuff pressures exceeding 30 cmH O. Although our study did not demonstrate that syringe size was predictive of ideal cuff pressure ranges, the average cuff pressure for the 5-mL group was 55.8 cm H O versus 68.8 cm H O in the 10-mL group.
Although both 5- and 10-mL syringes resulted in elevated cuff pressures after intubation, 5-mL syringes resulted in a lower degree of elevation. Use of a 5-mL syringe should be considered when inflating the endotracheal cuff to possibly reduce patient harm secondary to elevated cuff pressures. Further studies assessing smaller syringe sizes to reduce cuff pressures are warranted.
气管内导管套囊（ETTC）过度充气的风险必须与达到至少20 cm H₂O压力的需求相平衡。已经开发出一些方法来估计ETTC的适当加压，但无法提供准确的气管内导管套囊压力（ETCP）测量值。因此，不同尺寸的注射器可能在确定ETCP方面发挥作用。
确定推荐的ETCP所需的最佳注射器尺寸。
200例患者被随机分为使用10 mL注射器（标准注射器）或5 mL注射器（研究组）对ETTC进行充气。插入气管内导管后，由主治麻醉师对ETTC进行充气。在插管后10分钟内，使用医院提供的压力计测量ETCP。
5 mL组套囊压力在正常范围内的百分比为10.53%，10 mL组为6.78%。研究组84.21%（n = 64）和对照组91.53%（n = 54）的套囊压力超过30 cmH₂O。虽然我们的研究没有证明注射器尺寸可预测理想的套囊压力范围，但5 mL组的平均套囊压力为55.8 cm H₂O，而10 mL组为68.8 cm H₂O。
虽然5 mL和10 mL注射器在插管后都会导致套囊压力升高，但5 mL注射器导致的升高程度较低。在对气管内套囊充气时，应考虑使用5 mL注射器，以可能减少因套囊压力升高而对患者造成的伤害。有必要进一步研究评估更小尺寸的注射器以降低套囊压力。
