拔管前带套囊气管导管漏气试验及拔管后喉水肿：儿科重症监护病房患者的前瞻性单中心评估

Pre-Extubation Cuffed Tube Leak Test and Subsequent Post-Extubation Laryngeal Edema: Prospective, Single-Center Evaluation of PICU Patients.

作者信息

Kanno Koji, Fujiwara Naoki, Moromizato Takuhiro, Fujii Shuichi, Ami Yuki, Tokushige Akihiro, Ueda Shinichiro

机构信息

Division of Pediatric Critical Care Medicine, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan.

Department of Clinical Research and Quality Management, University of the Ryukyus Graduate School of Medicine, Okinawa, Japan.

出版信息

Pediatr Crit Care Med. 2023 Sep 1;24(9):767-774. doi: 10.1097/PCC.0000000000003282. Epub 2023 May 23.

DOI:10.1097/PCC.0000000000003282

PMID:37219965

Abstract

OBJECTIVES

We performed our standard air leak, leak percentage, and cuff leak percentage tests in pediatric patients intubated with microcuff pediatric tracheal tubes (MPTTs) just before extubation. We examined the association between test findings and the subsequent occurrence of post-extubation laryngeal edema (PLE).

DESIGN

Prospective, single-center, observational study.

SETTING

PICU (June 1, 2020 to May 31, 2021).

PATIENTS

Pediatric patients intubated and scheduled for extubation during the day shift in the PICU.

INTERVENTIONS

Multiple pre-extubation leak tests were performed on each patient immediately before extubation. In our center, the standard leak test is positive if a leak is audible at 30 cm H 2 O applied pressure with the MPTT cuff deflated. Two other tests were calculated in the pressure control-assist control ventilator mode using the following formulas: leak percentage with deflated cuff = (inspiratory tidal volume [V t ]-expiratory V t ) × 100/inspiratory V t ; cuff leak percentage = (expiratory V t with inflated cuff-expiratory V t with deflated cuff) × 100/expiratory V t with inflated cuff.

MEASUREMENTS AND MAIN RESULTS

The diagnostic criteria for PLE was made by at least two healthcare professionals and included upper airway stricture with stridor-requiring nebulized epinephrine. Eighty-five pediatric patients (< 15 yr) who had been intubated for at least 12 hours using the MPTT were included. Positive rates for the standard leak, leak percentage (cutoff 10%), and cuff leak percentage (cutoff 10%) tests were 0.27, 0.20, and 0.64, respectively. The standard leak, leak percentage, and cuff leak tests showed sensitivities of 0.36, 0.27, and 0.55, respectively; and specificities of 0.74, 0.81, and 0.35, respectively. PLE occurred in 11 of 85 patients (13%), and there were no instances of needing reintubation.

CONCLUSIONS

The pre-extubation leak tests in current practice for intubated pediatric patients in the PICU all lack diagnostic accuracy for PLE.

摘要

目的

我们在儿科患者拔管前，对使用微型套囊儿科气管导管（MPTT）进行气管插管的患者进行了标准漏气、漏气百分比和套囊漏气百分比测试。我们研究了测试结果与拔管后喉水肿（PLE）后续发生之间的关联。

设计

前瞻性、单中心观察性研究。

地点

儿科重症监护病房（2020年6月1日至2021年5月31日）。

患者

在儿科重症监护病房日班期间进行气管插管并计划拔管的儿科患者。

干预措施

在每位患者拔管前立即进行多次拔管前漏气测试。在我们中心，如果在MPTT套囊放气且施加30 cm H₂O压力时可听到漏气声，则标准漏气测试为阳性。在压力控制-辅助控制通气模式下，使用以下公式计算另外两项测试：套囊放气时的漏气百分比=（吸气潮气量[Vt]-呼气潮气量）×100/吸气潮气量；套囊漏气百分比=（套囊充气时的呼气潮气量-套囊放气时的呼气潮气量）×100/套囊充气时的呼气潮气量。

测量指标和主要结果

PLE的诊断标准由至少两名医护人员确定，包括伴有喘鸣的上气道狭窄且需要雾化肾上腺素治疗。纳入了85例（<15岁）使用MPTT进行气管插管至少12小时的儿科患者。标准漏气、漏气百分比（临界值10%）和套囊漏气百分比（临界值10%）测试的阳性率分别为0.27、0.20和0.64。标准漏气、漏气百分比和套囊漏气测试的敏感性分别为0.36、0.27和0.55；特异性分别为0.74、0.81和0.35。85例患者中有11例（13%）发生了PLE，且没有再次插管的情况。