Mu Guo, Wang Feixiang, Li Qiang, Yu Xuan, Lu Bin
Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, China.
Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.
Front Med (Lausanne). 2024 Nov 25;11:1468310. doi: 10.3389/fmed.2024.1468310. eCollection 2024.
The optimal endotracheal tube (ETT) cuff pressure remains contentious. In the traditional consideration that the level 30 cmHO is considered safe, balancing the prevention of reflux aspiration against airway mucosal damage. Whether this pressure level can cause potential damage to the airway mucosa remains to be discussed.
Airway mucosa damage and structural changes at 30 cmHO were examined in patients under general anesthesia and in rabbit mechanical ventilation models. Prior to this, we also interviewed some anesthesiologists about the level of concern about ETT cuff pressure.
A total of 634 valid questionnaires suggested that anesthesiologists generally do not pay enough attention to ETT cuff pressure and the average established cuff pressure significantly exceeded 30 cmHO. Airway mucosa images of 100 general anesthesia patients with different ventilation duration indicated that maintaining the pressure at 30 cmHO did not cause significant damage to airway mucosa in a short period of time, while it still caused damage to airway mucosa in patients with long-term ventilation, with damage severity increasing with longer ventilation periods. This correlated strongly with postoperative sore throat ( = 0.3884, < 0.001). In rabbits, 4 h of ventilation at this pressure resulted in significant loss of ciliated epithelium and inflammation. Calculations suggested an effective dose (ED) to prevent mucosal injury at a cuff pressure of 25.64 cmHO (95% CI: 19.268-29.367 cmHO).
The currently established cuff pressure of 30 cmHO is associated with airway mucosal damage in both clinical and animal models. Lowering the safety threshold of cuff pressure may be necessary to mitigate mucosal injury.
最佳气管内导管（ETT）套囊压力仍存在争议。传统观点认为30 cmH₂O的压力水平是安全的，兼顾了预防反流误吸与气道黏膜损伤。该压力水平是否会对气道黏膜造成潜在损伤仍有待探讨。
在全身麻醉患者和兔机械通气模型中检测30 cmH₂O时的气道黏膜损伤及结构变化。在此之前，我们还就对ETT套囊压力的关注程度采访了一些麻醉医生。
共634份有效问卷显示，麻醉医生普遍对ETT套囊压力关注不足，且平均设定的套囊压力显著超过30 cmH₂O。100例不同通气时长的全身麻醉患者的气道黏膜图像显示，在短时间内将压力维持在30 cmH₂O不会对气道黏膜造成显著损伤，但在长期通气患者中仍会导致气道黏膜损伤，且损伤严重程度随通气时间延长而增加。这与术后咽痛密切相关（r = 0.3884，P < 0.001）。在兔模型中，此压力下通气4小时导致纤毛上皮显著丢失和炎症。计算得出预防黏膜损伤的有效剂量（ED）为25.64 cmH₂O（95%CI：19.268 - 29.367 cmH₂O）。
目前设定的30 cmH₂O套囊压力在临床和动物模型中均与气道黏膜损伤相关。降低套囊压力的安全阈值可能有必要减轻黏膜损伤。
