Department of Anaesthesiology and Perioperative Medicine, Division of Paediatric Anaesthesiology, University of Pittsburgh School of Medicine, USA.
Ann Card Anaesth. 2020 Oct-Dec;23(4):447-452. doi: 10.4103/aca.ACA_143_19.
The concomitant use of cuffed endotracheal tubes (ETT) and transesophageal echocardiography (TEE) probes increases ETT cuff pressures (CP), which may contribute to mucosal ischemia and perioperative complications such as failed extubation.
To assess changes in ETT CP after TEE insertion in patients of different age groups undergoing congenital heart surgery and examine the relationship between ETT CP and postoperative extubation failure.
Single-center quality improvement project.
ETT CP was measured with a manometer following intubation and again after TEE insertion. Tracheal perfusion pressure was then calculated and postoperative extubation failures were recorded.
Chi-square testing, Fisher's-exact testing, one-way analysis of variance testing or Kruskal-Wallis testing with Dunn's pairwise, and student's t-test or Wilcoxon rank-sum testing were used to analyze the data.
Median ETT CP increased significantly after TEE insertion in each age group, with infants showing a smaller magnitude of increase (+2 [1-6] cm HO, P < 0.001) than adults (+12 [8-14] cm HO, P = 0.008) (intergroup comparison P = 0.002). Five patients (9%) failed extubation, all of which were infants. Within the infant subgroup, no significant difference existed between failed vs successful extubation regarding ETT CP during bypass (15 ± 1 vs 16 ± 2 mmHg, P = 0.206) or tracheal perfusion pressure pre-bypass (34 ± 9 vs 38 ± 11 mmHg, P = 0.518), during bypass (20 ± 9 vs 22 ± 6 mmHg, P = 0.697), or post-bypass (42 ± 9 vs 41 ± 9 mmHg, P = 0.923). There was a significant difference in cardiopulmonary bypass duration (151 ± 29 vs 85 ± 32 min, P < 0.001).
Factors beyond intraoperative ETT CP likely play a larger role in postoperative extubation failure.
使用带套囊的气管内导管（ETT）和经食管超声心动图（TEE）探头会增加 ETT 套囊压力（CP），这可能导致黏膜缺血和围手术期并发症，如拔管失败。
评估不同年龄组接受先天性心脏手术的患者在 TEE 插入后 ETT CP 的变化，并检查 ETT CP 与术后拔管失败之间的关系。
单中心质量改进项目。
在插管后和 TEE 插入后使用压力计测量 ETT CP，然后计算气管灌注压并记录术后拔管失败。
使用卡方检验、Fisher 精确检验、单向方差分析检验或 Kruskal-Wallis 检验加 Dunn 两两比较、学生 t 检验或 Wilcoxon 秩和检验来分析数据。
在每个年龄组中，TEE 插入后 ETT CP 均显著增加，婴儿的增加幅度较小（+2 [1-6] cm HO，P < 0.001），而成人的增加幅度较大（+12 [8-14] cm HO，P = 0.008）（组间比较 P = 0.002）。有 5 名患者（9%）拔管失败，均为婴儿。在婴儿亚组中，在体外循环期间，失败与成功拔管的 ETT CP 无显著差异（15 ± 1 与 16 ± 2 mmHg，P = 0.206）或体外循环前的气管灌注压（34 ± 9 与 38 ± 11 mmHg，P = 0.518）、体外循环期间（20 ± 9 与 22 ± 6 mmHg，P = 0.697）或体外循环后（42 ± 9 与 41 ± 9 mmHg，P = 0.923）。体外循环持续时间有显著差异（151 ± 29 与 85 ± 32 min，P < 0.001）。
术中 ETT CP 以外的因素可能在术后拔管失败中起更大作用。
