Shinohara Mafumi, Iwashita Masayuki, Abe Takeru, Takeuchi Ichiro
Advanced Critical Care and Emergency Center , Yokohama City University Medical Center, 4-57 Urafunecho Minamiku, Yokohama, Kanagawa, 232-0024, Japan.
BMC Emerg Med. 2022 Mar 31;22(1):55. doi: 10.1186/s12873-022-00615-7.
Computed tomography (CT) is often performed to assess patients; however, little is known about how airway size measured by CT scan imaging might influence the occurrence of post-extubation upper airway obstruction.
This study aimed to evaluate the association between airway size measured by CT and the incidence of post-extubation upper airway obstruction symptoms for each sex. This single-center observational study was conducted at a tertiary emergency medical center/severe trauma center with a 12-bed intensive care unit. We enrolled consecutive adult patients (aged ≥ 20 years), who were intubated in the emergency room, between January 2016 and March 2019. Patients who underwent a CT scan of the glottic region within three hours before and after intubation were included in the analysis. For each sex, we first divided the patients into two groups: those who had post-extubation stridor, hoarseness, or both and those who had no such symptoms. Then, we compared the two groups using the Mann-Whitney U test and Fisher's exact test. Univariate and multivariate logistic regression analyses were also performed.
During the 39 months, 855 patients were enrolled in this study. A total of 217 patients underwent CT of the glottic region within three hours before and after intubation. Five patients had no records of symptoms after extubation. Thus, we analyzed data from 212 patients. This study included 144 males and 68 females. In female patients, the median [inter-quartile range] (average) of the transverse diameter of the glottis/endotracheal tube outer diameter (OD) ratio was smaller in patients with post-extubation upper airway obstruction symptoms than in patients without the symptoms (1.00 [1.00-1.00] (0.9572) vs. 1.00 [1.00-1.00] (1.00296), respectively; p = .013). Multivariate logistic regression analysis showed that the glottis/tube OD ratio < 1 was associated with the symptoms in females (odds ratio: 95% confidence interval, 5.68: 1.04-30.97). There was no relation between the airway sizes and the symptoms in male patients.
In female patients, no gap between the endotracheal tube and the vocal codes or the glottic transverse diameter being smaller than the endotracheal tube OD on CT scan was associated with post-extubation upper airway obstruction symptoms.
计算机断层扫描（CT）常用于评估患者；然而，关于CT扫描成像测量的气道大小如何影响拔管后上气道梗阻的发生，人们知之甚少。
本研究旨在评估CT测量的气道大小与各性别拔管后上气道梗阻症状发生率之间的关联。这项单中心观察性研究在一家拥有12张床位的重症监护病房的三级急诊医疗中心/严重创伤中心进行。我们纳入了2016年1月至2019年3月期间在急诊室接受插管的连续成年患者（年龄≥20岁）。分析纳入在插管前后三小时内接受声门区域CT扫描的患者。对于每一性别，我们首先将患者分为两组：有拔管后喘鸣、声音嘶哑或两者皆有的患者，以及没有这些症状的患者。然后，我们使用曼-惠特尼U检验和费舍尔精确检验对两组进行比较。还进行了单因素和多因素逻辑回归分析。
在39个月期间，本研究共纳入855例患者。共有217例患者在插管前后三小时内接受了声门区域CT检查。5例患者拔管后无症状记录。因此，我们分析了212例患者的数据。本研究包括144例男性和68例女性。在女性患者中，有拔管后上气道梗阻症状的患者声门横径/气管导管外径（OD）比值的中位数[四分位间距]（平均值）低于无症状患者（分别为1.00[1.00 - 1.00]（0.9572）和1.00[1.00 - 1.00]（1.00296）；p = 0.013）。多因素逻辑回归分析显示，声门/导管OD比值<1与女性的症状相关（比值比：95%置信区间，5.68：1.04 - 30.97）。男性患者的气道大小与症状之间无关联。
在女性患者中，气管导管与声带之间无间隙或CT扫描显示声门横径小于气管导管外径与拔管后上气道梗阻症状相关。
