Duarte Nadia Maria da Conceição, Caetano Ana Maria Menezes, Arouca Gustavo de Oliveira, Ferrreira Andrea Tavares, Figueiredo José Luiz de
Universidade Federal de Pernambuco, Hospital das Clínicas, Departamento de Cirurgia, Recife, PE, Brasil.
Universidade Federal de Pernambuco, Hospital das Clínicas, Departamento de Cirurgia, Recife, PE, Brasil.
Braz J Anesthesiol. 2020 Jan-Feb;70(1):9-14. doi: 10.1016/j.bjan.2019.09.010. Epub 2020 Feb 19.
Poor monitoring of tracheal tube cuff pressure may result in patient complications. The objective method of using a manometer is recommended to keep safe cuff pressure values (20‒30 cm HO). However, as manometers are not readily available, anesthesiologists use subjective methods. We aimed to assess appropriateness of a subjective method for attaining cuff pressure and the expertise level of manometer handling among anesthesiology staff and residents in a university teaching hospital.
Prospective observational study, recruiting participants that performed tracheal intubation and the subjective method for tube cuff inflation. Patients with difficult airway, larynx and trachea anatomic abnormality and emergency procedures were not included. Up to 60 minutes after tracheal intubation, an investigator registered the cuff pressure using an aneroid manometer (AMBU®) connected to the tube pilot balloon.
Forty-seven anesthesiologists were included in the study – 24 residents and 23 staff. Mean (SD) and medians (IQR) measured in cmHO were, respectively, 52.5 (27.1) and 50 (30‒70). We registered 83% of measurements outside the recommended pressure range, with no difference between specialists and residents. The level of expertise with the objective method was also similar in both groups. Pressure adjustments were performed in 76.6% of cases.
The subjective method for inflating the tracheal tube cuff resulted in a high rate of inadequate cuff pressures, with no difference in performance between anesthesiology specialists and residents.
气管导管套囊压力监测不佳可能导致患者出现并发症。建议采用使用压力计的客观方法来维持安全的套囊压力值（20 - 30 cmH₂O）。然而，由于压力计不易获取，麻醉医生会使用主观方法。我们旨在评估一种主观方法在达到套囊压力方面的适用性，以及大学教学医院麻醉科工作人员和住院医师操作压力计的专业水平。
前瞻性观察性研究，招募进行气管插管并采用主观方法进行导管套囊充气的参与者。排除气道困难、喉和气管解剖异常以及急诊手术的患者。气管插管后长达60分钟，一名研究者使用连接到导管引导气囊的无液压力计（AMBU®）记录套囊压力。
47名麻醉医生纳入研究，其中24名住院医师和23名工作人员。以cmH₂O为单位测量的均值（标准差）和中位数（四分位间距）分别为52.5（27.1）和50（30 - 70）。我们记录到83%的测量值超出推荐压力范围，专科医生和住院医师之间无差异。两组在客观方法的专业水平方面也相似。76.6%的病例进行了压力调整。
气管导管套囊充气的主观方法导致套囊压力不足的发生率很高，麻醉专科医生和住院医师在操作表现上无差异。
