Nazari Roghieh, Sharif Nia Hamid, Hajihosseini Fatemeh, Beheshti Zahra, Panjoo Mojgan, Rahmatpour Pardis
Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran.
Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
Tanaffos. 2021 Jan;20(1):22-28.
Endotracheal tube cuff pressure must be kept in an optimal range, but it might change during some nursing procedures. If the cuff pressure gets outside the normal range, it can cause mucosal damage, insufficient ventilation, and microaspiration. This study aimed to determine the effect of endotracheal suctioning on cuff pressure in patients during mechanical ventilation.
This is a quasi-experimental study utilizing repeated measures with a within-subject design. Using a simple convenience sampling method, 61 patients were studied during intubation on mechanical ventilation. Baseline cuff pressure was adjusted to 25 cm H O. Then, at 15, 30, and 60 minutes' intervals, cuff pressures were measured once without suctioning and again after suctioning.
The results showed a significant change in the mean endotracheal tube cuff pressure during suctioning (p<0.001, d=7.47). During suctioning, cuff pressure exceeded the normal range in 64% of the patients. After suctioning, although endotracheal tube cuff pressure decreased in both conditions, it decreased more significantly (F (2.17, 260.55)=238.19, p<0.001, ν=0.665, d=1.37) in the suctioning condition.
The results suggest that endotracheal tube cuff pressure increases suddenly and briefly during suctioning, but within 60 minutes after suctioning, it becomes more reduced in suctioning conditions than without suctioning. Therefore, patients are at risk of mucosal damage and microaspiration after and during suctioning, respectively. It is suggested that nurses use continuous cuff pressure regulation methods to prevent potential risks.
气管内导管套囊压力必须保持在最佳范围内，但在某些护理操作过程中可能会发生变化。如果套囊压力超出正常范围，可能会导致黏膜损伤、通气不足和微量误吸。本研究旨在确定机械通气患者进行气管内吸痰时对套囊压力的影响。
这是一项采用重复测量的受试者内设计的准实验研究。采用简单便利抽样方法，对61例机械通气插管患者进行研究。将基线套囊压力调整至25 cm H₂O。然后，每隔15、30和60分钟，在不吸痰时测量一次套囊压力，吸痰后再次测量。
结果显示，吸痰过程中气管内导管套囊平均压力有显著变化（p<0.001，d=7.47）。吸痰过程中，64%的患者套囊压力超出正常范围。吸痰后，尽管两种情况下气管内导管套囊压力均下降，但在吸痰情况下下降更为显著（F(2.17, 260.55)=238.19，p<0.001，ν=0.665，d=1.37）。
结果表明，吸痰过程中气管内导管套囊压力会突然短暂升高，但在吸痰后60分钟内，与未吸痰相比，吸痰情况下压力下降幅度更大。因此，患者分别在吸痰后和吸痰过程中有黏膜损伤和微量误吸的风险。建议护士采用持续套囊压力调节方法以预防潜在风险。
