Ferdinande P, Kim D O
Department of Intensive Care Medicine, University Hospital, K.U. Leuven, Belgium.
Acta Otorhinolaryngol Belg. 1995;49(4):341-6.
Laryngotracheal complications after translaryngeal intubation and specifically tracheotomy are a common problem. Surgical correction of PITS is not always successful. Pathogenetic mechanisms of PITS are direct pressure necrosis by overinflated endotracheal tube and cuff material, duration of intubation, macro- and microtrauma during intubation, the specific technique of endotracheal intubation, severity of respiratory failure, infection and poor tissue perfusion due to hemodynamic instability. Following preventive guidelines are proposed: the use of high volume low pressure cuffs, cuff pressure monitoring, ventilatory support with lower airway pressures, prevention of macrotrauma during intubation and microtrauma during maintenance, adapted policy of choice between translaryngeal and tracheotomy techniques, anti-infectious strategy and swift hemodynamic stabilization.
经喉插管尤其是气管切开术后的喉气管并发症是一个常见问题。PITS的手术矫正并不总是成功的。PITS的发病机制包括气管内导管和套囊材料过度充气导致的直接压迫坏死、插管持续时间、插管过程中的宏观和微观创伤、气管内插管的具体技术、呼吸衰竭的严重程度、感染以及血流动力学不稳定导致的组织灌注不良。现提出以下预防指南：使用大容量低压套囊、监测套囊压力、采用较低气道压力进行通气支持、预防插管过程中的宏观创伤和维持过程中的微观创伤、在经喉和气管切开技术之间选择合适的策略、抗感染策略以及迅速稳定血流动力学。
