Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, 1-8 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
BMC Anesthesiol. 2021 Feb 3;21(1):34. doi: 10.1186/s12871-021-01258-0.
The insertion of inappropriately sized uncuffed endotracheal tubes (ETTs) with a tight seal or presence of air leakage may be necessary in children. This study aimed to analyze the frequency of the requirement of inappropriately sized uncuffed ETT insertion, air leakage after the ETT was replaced with one of a larger size, and factors associated with air leakage after ETT replacement.
Patients under 2 years of age who underwent oral surgery under general anesthesia with uncuffed ETTs between December 2013 and May 2015 were enrolled. The ETT size was selected at the discretion of the attending anesthesiologists. A leak test was performed after intubation. The ETT was replaced when considered necessary. Data regarding the leak pressure (P) and inspiratory and expiratory tidal volumes were extracted from anesthesia records. We considered a P of 10 < P ≤ 30 cmHO to be appropriate. The frequencies of the requirement of inappropriately sized ETTs, absence of leakage after ETT replacement, ETT size difference, and leak rate were calculated. A logistic regression was performed, with P, leak rate, and size difference included as explanatory variables and presence of leakage after replacement as the outcome variable.
Out of the 156 patients enrolled, 109 underwent ETT replacement, with the requirement of inappropriately sized ETTs being observed in 25 patients (23%). ETT replacement was performed in patients with P ≤ 10 cmHO; leakage was absent after replacement (P < 30 cmHO) in 52% of patients (25/48). In the multivariate logistic model, the leak rate before ETT replacement was significantly associated with the presence of leakage after replacement (p = 0.021).
Inappropriately sized ETTs were inserted in approximately 23% of the patients. The leak rate may be useful to guide ETT replacement.
在儿童中，可能需要插入大小不合适的无套囊气管内导管（ETT），并保持紧密密封或存在空气泄漏。本研究旨在分析需要插入大小不合适的无套囊 ETT 的频率、更换较大尺寸 ETT 后出现的空气泄漏情况，以及与更换 ETT 后出现空气泄漏相关的因素。
纳入 2013 年 12 月至 2015 年 5 月期间在全身麻醉下接受口腔手术并使用无套囊 ETT 的 2 岁以下患者。ETT 尺寸由主治麻醉师决定。插管后进行漏气试验。当认为有必要时更换 ETT。从麻醉记录中提取泄漏压力（P）和吸气及呼气潮气量的数据。我们认为 10< P ≤ 30 cmHO 的 P 值为合适。计算需要大小不合适的 ETT、更换 ETT 后无泄漏、ETT 尺寸差异和泄漏率的频率。进行逻辑回归分析，将 P、泄漏率和尺寸差异作为解释变量，将更换后是否存在泄漏作为结果变量。
在纳入的 156 名患者中，有 109 名患者更换了 ETT，其中 25 名患者（23%）需要插入大小不合适的 ETT。在 P ≤ 10 cmHO 的患者中进行了 ETT 更换；在更换后，52%的患者（25/48）无泄漏（P < 30 cmHO）。在多变量逻辑模型中，更换 ETT 前的泄漏率与更换后是否存在泄漏显著相关（p = 0.021）。
大约 23%的患者插入了大小不合适的 ETT。泄漏率可能有助于指导 ETT 更换。
