Nwosu Arinze Duke George, Ossai Edmund Ndudi, Ejezie Chijioke, Obodo Odichimma Callista
Department of Anaesthesia, National Orthopaedic Hospital, Enugu, Nigeria.
Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria.
J West Afr Coll Surg. 2025 Jan-Mar;15(1):53-58. doi: 10.4103/jwas.jwas_162_23. Epub 2024 Aug 2.
Considerable morbidity is attributable to inappropriate tracheal cuff pressure. An earlier study undertaken in our hospital revealed that a normal cuff pressure of 20-30 cm HO was achieved in only 6% of intubated patients using subjective estimation methods.
To determine whether a training intervention could improve the accuracy of the subjective estimation method in our tracheal cuff monitoring.
A 1-day training session was conducted in April 2022 for our anaesthesia providers. The cuffs of different sizes of endotracheal tubes were inflated to 25 cm HO, and each staff was requested to feel the turgor of the pilot balloon. Subsequently, anaesthesia providers used pilot balloon palpation for the regulation of the tracheal cuff pressure in consecutive patients undergoing general anaesthesia with endotracheal intubation. During each intubation, a manometer was used to crosscheck the inflated cuff pressure objectively. The incidence of post-operative sore throat was also evaluated. The obtained outcomes were compared with pre-intervention data obtained from an earlier study conducted in the health facility from October 2020 to September 2021. Significant differences were considered when < 0.05.
The mean tracheal cuff pressure was improved post-intervention (49.2 ± 24.1 cm HO versus 77.1 ± 31.1 cm HO; < 0.001). A significantly higher proportion of tracheal cuffs (20%; 31/156) were inflated within the normal range compared to 6% (9/141) prior to the intervention ( = 0.003). Fewer patients developed post-operative sore throat following the educational intervention (32.8%; 41/125) versus pre-intervention (47.7%; 53/111; = 0.019).
The educational intervention improved the safety of tracheal cuff management, which could positively impact airway management, especially in poor resource settings without cuff manometers.
相当一部分发病率可归因于气管套囊压力不当。我院早期开展的一项研究表明，采用主观估计方法时，仅6%的插管患者能达到20 - 30 cmH₂O的正常套囊压力。
确定培训干预是否能提高我院气管套囊监测中主观估计方法的准确性。
2022年4月为我院麻醉医护人员举办了为期1天的培训课程。将不同尺寸气管内导管的套囊充气至25 cmH₂O，要求每位工作人员感受指示球囊的张力。随后，麻醉医护人员在连续接受气管插管全身麻醉的患者中，使用指示球囊触诊法调节气管套囊压力。每次插管时，使用压力计客观地反复核对充气后的套囊压力。还评估了术后咽痛的发生率。将获得的结果与2020年10月至2021年9月在该医疗机构进行的早期研究中获得的干预前数据进行比较。当P < 0.05时认为存在显著差异。
干预后气管套囊平均压力有所改善（49.2 ± 24.1 cmH₂O对77.1 ± 31.1 cmH₂O；P < 0.001）。与干预前的6%（9/141）相比，套囊充气在正常范围内的比例显著更高（20%；31/156）（P = 0.003）。与干预前（47.7%；53/111）相比，教育干预后发生术后咽痛的患者更少（32.8%；41/125；P = 0.019）。
教育干预提高了气管套囊管理的安全性，这可能对气道管理产生积极影响，尤其是在没有套囊压力计的资源匮乏环境中。
