Service d'anesthésie-réanimation, hôpital Laënnec, centre hospitalier universitaire de Nantes, boulevard Jacques-Monod, Saint-Herblain, 44093 Nantes cedex 1, France.
Service d'anesthésie-réanimation, Hôtel-Dieu, centre hospitalier universitaire, 44093, Nantes, France.
Anaesth Crit Care Pain Med. 2020 Jun;39(3):435-441. doi: 10.1016/j.accpm.2020.04.007. Epub 2020 May 4.
Intermittent manual correction of the endotracheal tube cuff pressure (P) may delay the detection of underinflation (source of contaminated oropharyngeal content microaspiration) or overinflation (exposing to airway damage). Devices for automated continuous correction of P are appealing but some are inconvenient, expensive or even harmful. This prospective randomised controlled study tested whether the tracoe Smart Cuff Manager™ reduced the rate of patients undergoing≥1 episode of underinflation (P<20 cmHO), as compared with routine manual P correction. The rate of patients with≥1 overinflation episode (P>30 cmHO) and the incidence of under/overinflation were also compared.
Patients with acute brain injury and likely to receive invasive mechanical ventilation for>48h were randomly allocated to receive, during 48h, automated P correction (combined with manual correction) or manual correction alone. P was measured with a dedicated manual manometer, at least every 8h.
Sixty patients were included and randomised (32 patients with manual and 28 with automated P correction) for 506 measurements of P (269 and 237, respectively). Automated correction of P was associated with a lower rate of patients with≥1 episode of underinflation (63% and 18%, respectively, P<0.001), a lower incidence of underinflation episodes (15% vs. 2%; P<0.001), a lower rate of manual corrections (77% vs. 58%; P<0.001). For overinflation, there were no significant between-groups differences (2% vs. 2%). The incidence of early respiratory infections was similar in both groups (29% vs. 25%, P=0.78).
The adjunction of continuous P control with the Tracoe Smart Cuff Manager™ to routine manual intermittent correction reduced the incidence of P underinflation episodes without provoking overinflation.
ClinicalTrials NCT03330379. Registered 6 November 2017, https://clinicaltrials.gov/ct2/show/NCT03330379.
间歇性手动校正气管内管套囊压力（P）可能会延迟对充气不足（污染的口咽内容物微吸入源）或充气过度（暴露于气道损伤）的检测。用于自动连续校正 P 的设备很有吸引力，但有些设备不方便、昂贵，甚至有害。这项前瞻性随机对照研究测试了 tracoe Smart Cuff Manager™ 是否能降低患者接受≥1 次充气不足（P<20cmHO）的发生率，与常规手动 P 校正相比。还比较了≥1 次充气过度（P>30cmHO）的发生率和充气不足/过度的发生率。
患有急性脑损伤且可能需要接受>48 小时的有创机械通气的患者，随机分配接受 48 小时的自动 P 校正（与手动校正相结合）或单独手动校正。使用专用的手动测压器至少每 8 小时测量一次 P。
共纳入 60 例患者，并随机分配（32 例患者接受手动 P 校正，28 例患者接受自动 P 校正）进行 506 次 P 测量（分别为 269 次和 237 次）。自动校正 P 与患者接受≥1 次充气不足的发生率较低相关（分别为 63%和 18%，P<0.001），充气不足发生率较低（15%与 2%；P<0.001），手动校正率较低（77%与 58%；P<0.001）。对于充气过度，两组之间没有显著差异（2%与 2%）。两组的早期呼吸道感染发生率相似（29%与 25%，P=0.78）。
将 Tracoe Smart Cuff Manager™ 的连续 P 控制与常规手动间歇校正相结合，可降低 P 充气不足发生率，而不会引起充气过度。
ClinicalTrials NCT03330379。于 2017 年 11 月 6 日注册，https://clinicaltrials.gov/ct2/show/NCT03330379。
