Krafft P, Röggla M, Fridrich P, Locker G J, Frass M, Benumof J L
Department of Anesthesiology and General Intensive Care, University of Vienna, Austria.
Anesthesiology. 1997 May;86(5):1041-5. doi: 10.1097/00000542-199705000-00006.
The esophageal-tracheal Combitube (Kendall-Sheridan Catheter Corp., Argyle, NY) is an effective device for providing adequate gas exchange. However, tracheal suctioning is impossible with the Combitube placed in the esophageal position. To eliminate this disadvantage, the Combitube was redesigned by creating an enlarged hole in the pharyngeal lumen that allows fiberoptic access, tracheal suctioning, and tube exchange over a guide wire.
The two anterior, proximal perforations of regular Combitubes were replaced by a larger, ellipsoid-shaped hole. After the study was approved by the institutional review board, 20 patients with normal airways (Mallampati I or II) were studied. During general anesthesia, patients were esophageally intubated with the Combitube. A flexible bronchoscope was inserted and guided via the modified hole and glottic opening down the trachea. For the replacement procedure, a J tip guide wire was introduced through the bronchoscope. The bronchoscope and the Combitube were removed and a standard endotracheal tube was advanced over a guide catheter.
Bronchoscopic evaluation of the trachea and guided replacement of the Combitube by an endotracheal tube was successful in all 20 study patients. The average time needed to perform airway exchange was 90 +/- 20 s (mean +/- SD). Arterial oxygen saturation and end-tidal carbon dioxide levels remained normal in all patients. No case of laryngeal trauma was observed during intubation or the airway exchange procedure.
The redesigned Combitube enables fiberoptic bronchoscopy, fine-tuning of its position in the esophagus, and guided airway exchange in patients with normal airways. Further studies are warranted to demonstrate its value in patients with abnormal airways.
食管气管联合导管（肯德尔 - 谢里丹导管公司，纽约州阿盖尔）是一种能实现充分气体交换的有效设备。然而，当联合导管处于食管位置时无法进行气管吸引。为消除这一缺点，对联合导管进行了重新设计，在咽部管腔中制造了一个扩大的孔，以便进行纤维支气管镜检查、气管吸引以及通过导丝更换导管。
常规联合导管的两个前部近端穿孔被一个更大的椭圆形孔取代。在该研究获得机构审查委员会批准后，对20例气道正常（马兰帕蒂I或II级）的患者进行了研究。在全身麻醉期间，用联合导管对患者进行食管插管。插入一根可弯曲支气管镜，并通过改良孔和声门开口引导至气管。对于更换操作，通过支气管镜插入一根J形头导丝。移除支气管镜和联合导管，然后将一根标准气管导管沿导引导管推进。
对所有20例研究患者进行气管的支气管镜评估以及通过气管导管引导更换联合导管均获成功。进行气道更换所需的平均时间为90±20秒（均值±标准差）。所有患者的动脉血氧饱和度和呼气末二氧化碳水平均保持正常。在插管或气道更换过程中未观察到喉损伤病例。
重新设计的联合导管能够在气道正常的患者中进行纤维支气管镜检查、在食管中微调其位置以及引导气道更换。有必要进一步研究以证明其在气道异常患者中的价值。
