Deakers T W, Reynolds G, Stretton M, Newth C J
Division of Pediatric Intensive Care, Children's Hospital of Los Angeles, University of Southern California School of Medicine 90027.
J Pediatr. 1994 Jul;125(1):57-62. doi: 10.1016/s0022-3476(94)70121-0.
We prospectively studied 282 consecutive tracheal intubations (243 patients) in a pediatric intensive care unit during a 7-month period to compare cuffed and uncuffed endotracheal tube (ETT) utilization and outcome. The incidence of postextubation stridor in each ETT group was the major outcome measure after controlling for various patient risk factors. Patients whose ETTs were inserted in the operating room, who were less than 1 year of age, or who had ETTs in place for less than 72 hours were more likely to have had insertion of an uncuffed ETT. Patients whose ETTs were inserted in the emergency department or who were more than 5 years of age were more likely to have had insertion of a cuffed ETT. Those who had a cuffed ETT were older (mean 8.1 vs 2.5 years) and had ETTs in place longer (mean 6.1 vs 3.7 days) than patients with an uncuffed ETT. Of the 188 patients who subsequently had removal of their ETTs, the overall incidence of postextubation stridor was 14.9%, with no significant difference between the two ETT groups even after controlling for patient age, duration of intubation, trauma, leak around ETT before extubation, and pediatric risk of mortality score. Two patients in the cuffed ETT group and four patients in the uncuffed ETT group required reintubation for severe postextubation stridor. Long-term follow-up identified 33 patients (17%) who required hospital readmission. None of these was admitted with an upper airway problem. Two patients who previously had insertion of a cuffed ETT subsequently received tracheostomies for the primary purpose of long-term mechanical ventilation unrelated to any problem with the upper airway. We conclude that cuffed endotracheal intubation is not associated with an increased risk of postextubation stridor or significant long-term sequelae.
我们前瞻性地研究了在7个月期间儿科重症监护病房连续进行的282例气管插管（涉及243例患者），以比较带套囊和不带套囊气管内导管（ETT）的使用情况及结果。在控制各种患者风险因素后，每组ETT拔管后喘鸣的发生率是主要结局指标。在手术室插入ETT、年龄小于1岁或ETT留置时间少于72小时的患者更有可能插入不带套囊的ETT。在急诊科插入ETT或年龄大于5岁的患者更有可能插入带套囊的ETT。与使用不带套囊ETT的患者相比，使用带套囊ETT的患者年龄更大（平均8.1岁对2.5岁），ETT留置时间更长（平均6.1天对3.7天）。在随后拔除ETT的188例患者中，拔管后喘鸣的总体发生率为14.9%，即使在控制患者年龄、插管持续时间、创伤、拔管前ETT周围漏气以及儿科死亡风险评分后，两组ETT之间也没有显著差异。带套囊ETT组有2例患者，不带套囊ETT组有4例患者因严重的拔管后喘鸣需要重新插管。长期随访发现33例患者（17%）需要再次入院。这些患者均未因上呼吸道问题入院。两名先前插入带套囊ETT的患者随后接受了气管切开术，主要目的是进行长期机械通气，与上呼吸道任何问题无关。我们得出结论，带套囊气管插管与拔管后喘鸣风险增加或显著的长期后遗症无关。
