Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
BMC Anesthesiol. 2024 Nov 5;24(1):399. doi: 10.1186/s12871-024-02780-7.
Cuffed endotracheal tubes (ETTs) are commonly used in pediatric patients, with the gold standard for measuring cuff pressure being a cuff pressure manometer. However, this equipment is not always available in every operating room. Subjective inflation techniques, such as the minimal occluding volume (MOV) technique and the stethoscope-guided (Steth) technique, offer convenient and safe alternatives to standard methods but do not provide quantitative measurements. This study aimed to evaluate ETT cuff pressures and volumes of air inflated using the two subjective techniques (MOV and Steth) in pediatric patients.
This prospective observational study was conducted at the Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Thailand. We included healthy pediatric patients aged 2 to 7 years undergoing elective surgeries under general anesthesia with a cuffed ETT. The primary objective of this study was to compare the mean ETT cuff pressures and volumes of air inflated using the two subjective inflation techniques (MOV and Steth method). The secondary objectives include identifying factors associated with inappropriate inflation and evaluating post-intubation complications.
Sixty-four pediatric patients were analyzed. The overall mean ETT cuff pressure was 26.52 ± 8.68 cmHO. The target was achieved in 46.88% of patients, with overinflation in 32.81% and underinflation in 20.31%. The mean ETT cuff pressure in the MOV group was 27.77 ± 8.89 cmHO and in the Steth group was 25.33 ± 8.34 cmHO, with a non-significant mean difference of 2.44 cmHO (95% CI [-1.89, 6.77], p = 0.264). The mean volume of air inflated in the MOV group was 0.78 ± 0.25 ml, and in the Steth group was 0.68 ± 0.22 ml, with a non-significant mean difference of 0.10 ml (95% CI [-0.01, 0.22], p = 0.084). Younger age, lower weight, and shorter height were significantly associated with an increased risk of overinflation. An ETT size with an internal diameter (ID) of 5 mm was significantly associated with an increased risk of underinflation. No post-intubation complications were reported.
Subjective inflation techniques (MOV or Steth) achieve target ETT cuff pressures in less than 50%, and carry the risks of both overinflation and underinflation, even without post-intubation complications.
TCTR20211016001 (registered with the Thai Clinical Trials Registry on October 16, 2021).
带套囊的气管内导管（ETT）常用于儿科患者，测量套囊压力的金标准是套囊压力测压计。然而，并非每个手术室都能提供这种设备。主观充气技术，如最小封闭容积（MOV）技术和听诊器引导（Steth）技术，为标准方法提供了方便且安全的替代方法，但不能提供定量测量。本研究旨在评估小儿患者使用两种主观技术（MOV 和 Steth）充气的 ETT 套囊压力和空气量。
这是一项在泰国孔敬大学医学院麻醉科进行的前瞻性观察研究。我们纳入了在全身麻醉下接受择期手术的 2 至 7 岁健康小儿患者，使用带套囊的 ETT。本研究的主要目的是比较两种主观充气技术（MOV 和 Steth 法）充气的 ETT 套囊压力和空气量。次要目标包括确定与充气不当相关的因素和评估插管后并发症。
共分析了 64 例小儿患者。总体而言，ETT 套囊平均压力为 26.52±8.68cmHO。46.88%的患者达到目标压力，其中 32.81%存在过度充气，20.31%存在充气不足。MOV 组的 ETT 套囊平均压力为 27.77±8.89cmHO，Steth 组为 25.33±8.34cmHO，平均差异无统计学意义（2.44cmHO；95%CI[-1.89,6.77]，p=0.264）。MOV 组充气的平均空气量为 0.78±0.25ml，Steth 组为 0.68±0.22ml，平均差异无统计学意义（0.10ml；95%CI[-0.01,0.22]，p=0.084）。年龄较小、体重较低和身高较矮与过度充气的风险增加显著相关。内径（ID）为 5mm 的 ETT 大小与充气不足的风险增加显著相关。未报告插管后并发症。
主观充气技术（MOV 或 Steth）充气不到 50%可达到目标 ETT 套囊压力，但即使没有插管后并发症，也存在过度充气和充气不足的风险。
TCTR20211016001（于 2021 年 10 月 16 日在泰国临床试验注册中心注册）。
