Schmidt-Deubig Ilka, Kemper Michael, Wendel-Garcia Pedro D, Weiss Markus, Thomas Jörg, Both Christian Peter, Schmitz Achim
Department of Anesthesia, University Children's Hospital, Lenggstrasse 30, 8008, Zurich, Switzerland.
Department of Anesthesiology, RWTH University Hospital, Aachen, Germany.
Anaesthesiologie. 2024 Dec;73(12):829-836. doi: 10.1007/s00101-024-01486-2. Epub 2024 Nov 28.
Cuffed endotracheal tubes (cETT) pose the potential advantage of an infrequent need for reintubation in pediatric patients compared to uncuffed tubes. The aim of this study was to investigate tube exchange rates using second generation Microcuff® pediatric endotracheal tubes (PET) with an adapted sizing recommendation in a large single institution cohort of children and to identify potential variables associated with an elevated risk of tube exchange.
Patient data obtained from the electronic patient data management system of the Department of Anesthesia, University Children's Hospital Zurich, Switzerland, were retrospectively assessed for demographic and anthropometric information, size of the internal tube diameter used for positive pressure ventilation and divergence from the size recommendation chart.
Data from 14,188 children younger than 16 years (median 5.3 years) and weighing at least 3 kg who underwent oral or nasal tracheal intubation using second generation Microcuff® PET between 2009 and 2015 were included. Of 13,219 oral tracheal intubations 12,049 (84.9%) were performed according to the manufacturer's size recommendation and 1170 with divergent endotracheal tubes. The odds ratio (OR) of oral reintubation was 0.13% (95% confidence interval 0.08-0.22%) for cases using the manufacture's size recommendation correctly and 22.74% (95% confidence interval 20.42-25.23%) for patients intubated with a not recommended tube (p < 0.0001).
These findings indicate that the second generation Microcuff® PETs can be reliably used with low tube exchange rates across the entire pediatric age range when the tube size is selected according to the manufacturer's size recommendation chart. Adherence to the manufacturer's tube size recommendation is urgently advised.
与无套囊气管导管相比，有套囊气管导管（cETT）在儿科患者中具有较少需要再次插管的潜在优势。本研究的目的是在一个大型单机构儿童队列中，调查使用第二代Microcuff®儿科气管导管（PET）并采用适应性尺寸推荐时的导管更换率，并确定与导管更换风险升高相关的潜在变量。
回顾性评估从瑞士苏黎世大学儿童医院麻醉科电子患者数据管理系统获得的患者数据，以获取人口统计学和人体测量学信息、用于正压通气的内导管直径大小以及与尺寸推荐图表的差异。
纳入了2009年至2015年间14188名16岁以下（中位数5.3岁）且体重至少3千克、使用第二代Microcuff® PET进行口腔或鼻腔气管插管的儿童数据。在13219次口腔气管插管中，12049次（84.9%）是根据制造商的尺寸推荐进行的，1170次使用了不同的气管导管。正确使用制造商尺寸推荐的病例口腔再次插管的比值比（OR）为0.13%（95%置信区间0.08 - 0.22%），而使用未推荐导管插管的患者为22.74%（95%置信区间20.42 - 25.23%）（p < 0.0001）。
这些发现表明，当根据制造商的尺寸推荐图表选择导管尺寸时，第二代Microcuff® PET在整个儿科年龄范围内均可可靠使用，且导管更换率较低。强烈建议遵循制造商的导管尺寸推荐。
