Khan A B, Thandrayen K, Omar S
Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
South Afr J Crit Care. 2019 Aug 15;35(1). doi: 10.7196/SAJCC.2019.v35i1.373. eCollection 2019.
Intubated patients with a high tracheal tube cuff pressure (CP) are at risk of developing tracheal or subglottic stenosis. Recently an increasing number of patients have presented to our hospital with these complications.
To determine the frequency of tracheal tube CP measurements and the range of CP and to explore nursing knowledge regarding CP monitoring.
Frequency of CP measurement was assessed using a prospective chart review, followed by an interventional component. In the final stage nurses completed a self-administered questionnaire.
A total of 304 charts from 61 patients were reviewed. Patients' ages ranged from 1 to 71 years, with a male preponderance (1.5:1). The majority of charts (87%) did not reflect a documented CP measurement and only 12 charts showed at least one measurement per shift. Only 17% of recorded CPs were within the recommended range; 59% were too low. The questionnaire was completed by only 51% of the 75 respondents. Nursing experience ranged from 3 to 35 years and 92% of respondents were trained in critical care. Knowledge of current critical care CP monitoring guidelines was reported by 62% of the respondents (n=23/37). Only 53% (20/38) reported routinely measuring CP. Almost all respondents (94%) knew of at least one complication of abnormal CP.
Having a basic knowledge of CP measurement, having awareness of the complications of abnormal CP and the availability of national best practice guidelines did not translate into appropriate ICU practice. Research into effective implementation strategies to achieve best practice is needed.
Basic knowledge of cuff pressure measurement may not always result in best practice.Improvement in current practice requires research into effective implementation strategies.
气管导管套囊压力（CP）较高的插管患者有发生气管或声门下狭窄的风险。最近，越来越多出现这些并发症的患者前来我院就诊。
确定气管导管CP测量的频率、CP范围，并探讨护士关于CP监测的知识。
通过前瞻性病历审查评估CP测量频率，随后进行干预部分。在最后阶段，护士完成一份自填式问卷。
共审查了61例患者的304份病历。患者年龄从1岁到71岁不等，男性占多数（1.5:1）。大多数病历（87%）未反映有记录的CP测量值，只有12份病历显示每班至少有一次测量。记录的CP值中只有17%在推荐范围内；59%过低。75名受访者中只有51%完成了问卷。护理经验从3年到35年不等，92%的受访者接受过重症监护培训。62%的受访者（n = 23/37）报告了解当前重症监护CP监测指南。只有53%（20/38）报告常规测量CP。几乎所有受访者（94%）都知道CP异常的至少一种并发症。
掌握CP测量的基本知识、了解CP异常的并发症以及有国家最佳实践指南，并不意味着在重症监护病房能有恰当的实践。需要对实现最佳实践的有效实施策略进行研究。
套囊压力测量的基本知识不一定总能带来最佳实践。当前实践的改进需要对有效实施策略进行研究。
