Combret Yann, Machefert Margaux, Prieur Guillaume, Fresnel Emeline, Artaud-Macari Elise, Lamia Bouchra, Lebret Marius, Medrinal Clément
Université Paris-Saclay, UVSQ, Erphan, 78000, Versailles, France.
Intensive Care Unit Department, Le Havre Hospital, Avenue Pierre Mendes France, 76290, Montivilliers, France.
Intensive Care Med Exp. 2024 Jul 8;12(1):63. doi: 10.1186/s40635-024-00648-1.
Tracheostomized patients often present with muscle weakness, altered consciousness, or swallowing difficulties. Hence, the literature is scarce regarding the challenging management of tracheostomy weaning. There is a need to strengthen the understanding of respiratory mechanisms with the different tracheostomy tube modalities that compose this weaning pathway. We aimed to evaluate the impact of these modalities on the work of breathing (WOB), total positive end-expiratory pressure (PEEPtot), and tidal volume (V).
With a three-dimensional (3D) printed head mimicking human upper airways, we added a tracheal extension, and pierced to allow insertion of a size 7.0 tracheostomy cannula. The whole was connected to an artificial lung. Three lung mechanics were simulated (normal, obstructive and restrictive). We compared five different tracheostomy tube modalities to a control scenario in which the tube was capped and the cuff was deflated.
A marginal difference was observed on the WOB within conditions with a slight increase + 0.004 [95% CI (0.003-0.004); p < 0.001] when the cuff was inflated in the normal and restrictive models and a slight decrease in the obstructive model. The highest PEEPtot that was reached was + 1 cmHO [95% CI (1-1.1); p < 0.001] with high-flow therapy (HFT) with the cuff inflated in the obstructive model. We observed a statistically significant reduction in V [up to - 57 mL 95% CI (- 60 to - 54); p < 0.001] when the cuff was inflated, in both the normal and obstructive models.
Our results support the use of conditions that involve cuff deflation. Intermediate modalities with the cuff deflated produced similar results than cannula capping.
气管切开患者常伴有肌肉无力、意识改变或吞咽困难。因此，关于气管切开撤机这一具有挑战性的管理方面的文献较少。有必要加强对构成该撤机途径的不同气管切开导管模式下呼吸机制的理解。我们旨在评估这些模式对呼吸功（WOB）、总呼气末正压（PEEPtot）和潮气量（V）的影响。
使用一个模拟人类上呼吸道的三维（3D）打印头部，添加一个气管延长部分，并打孔以允许插入7.0号气管切开套管。整体连接到一个人工肺。模拟了三种肺力学情况（正常、阻塞性和限制性）。我们将五种不同的气管切开导管模式与一种对照情况进行比较，在对照情况下，导管被封堵且套囊放气。
在正常和限制性模型中，当套囊充气时，WOB有微小差异，略有增加 +0.004 [95%可信区间（0.003 - 0.004）；p <0.00]，而在阻塞性模型中略有下降。在阻塞性模型中，套囊充气时采用高流量治疗（HFT）达到的最高PEEPtot为 +1 cmH₂O [95%可信区间（1 - 1.1）；p <0.001]。当套囊充气时，在正常和阻塞性模型中，我们均观察到V有统计学意义的降低[高达 -57 mL 95%可信区间（-60至 -54）；p <0.001]。
我们的结果支持使用套囊放气的情况。套囊放气的中间模式产生的结果与封堵套管相似。
