Ananthan Prakkash P, Ho Kwok M, Anstey Matthew H, Wibrow Bradley A
Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Australia.
Department of Intensive Care Medicine, Sir Charles Gairdner Hospital, Perth, Australia.
Anaesth Intensive Care. 2022 May;50(3):243-249. doi: 10.1177/0310057X211039226. Epub 2021 Dec 6.
Tracheostomy tubes are chosen primarily based on their internal diameter; however, the length of the tube may also be important. We performed a prospective clinical audit of 30 critically ill patients following tracheostomy to identify the type of tracheostomy tube inserted, the incidence of malpositioning and the factors associated with the need to change the tracheostomy tube subsequently. Anthropometric neck measurements, distance between the skin and tracheal rings and the position of the tracheostomy cuff relative to the tracheal stoma were recorded and analysed. Malpositioning of the tracheostomy tube was noted in 20%, with a high riding cuff being the most common cause of malpositioning, resulting in an audible leak and a need to change the tracheostomy tube subsequently. A high riding cuff was more common when a small tracheostomy tube (e.g. Portex (Smiths Medical Australasia, Macquarie Park, NSW) ≤8.0 mm internal diameter with length <7.5 cm) was used, with risk further increased when the patient's skin to trachea depth was greater than 0.8 cm. Identifying a high riding cuff relative to the tracheal stoma confirmed by a translaryngeal bronchoscopy strongly predicted the risk of air leak and the need to change the tracheostomy tube subsequently. Our study suggests that when a small (and short) tracheostomy tube is planned for use, intraoperative translaryngeal bronchoscopy is warranted to exclude malpositioning of the tracheostomy tube with a high riding cuff.
气管造口管的选择主要基于其内径；然而，管子的长度也可能很重要。我们对30例气管造口术后的重症患者进行了一项前瞻性临床审计，以确定所插入气管造口管的类型、位置不当的发生率以及与随后需要更换气管造口管相关的因素。记录并分析了人体测量的颈部尺寸、皮肤与气管环之间的距离以及气管造口套管相对于气管造口的位置。20%的患者出现气管造口管位置不当，其中高位套囊是位置不当的最常见原因，导致可闻及漏气，并随后需要更换气管造口管。当使用小口径气管造口管（例如内径≤8.0毫米、长度<7.5厘米的Portex管（史密斯医疗澳大利亚公司，新南威尔士州麦格理公园））时，高位套囊更为常见，当患者皮肤至气管的深度大于0.8厘米时，风险会进一步增加。经经喉支气管镜检查证实相对于气管造口存在高位套囊，强烈预示着漏气风险以及随后更换气管造口管的必要性。我们的研究表明，当计划使用小（且短）的气管造口管时，术中经喉支气管镜检查有助于排除气管造口管高位套囊的位置不当情况。
