Straus C, Louis B, Isabey D, Lemaire F, Harf A, Brochard L
Service de Réanimation Médicale, INSERM U296, Hôpital Henri Mondor, Créteil, France.
Am J Respir Crit Care Med. 1998 Jan;157(1):23-30. doi: 10.1164/ajrccm.157.1.96-10057.
The influence of the endotracheal tube (ETT) during a T-piece trial remains controversial. Our aim was to compare the work of breathing of 14 successfully extubated patients at the end of a 2-h trial (T) and after extubation (E) of the trachea, and to assess, using the acoustic reflection method, the resistance of the endotracheal tube and of the supraglottic airway as well as their related work. We found that the work of breathing of the patients was identical between T and E (1.72 +/- 0.59 versus 1.63 +/- 0.45 J/L; p = 0.50 and 23.5 +/- 10.6 versus 22.6 +/- 9.7 J/min; p = 0.70). There was no significant difference between the beginning and the end of the T-piece trial (1.57 +/- 0.53 versus 1.72 +/- 0.59 J/ L, p = 0.10). The work caused by the ETT amounted to 11.0 +/- 3.9% of the total work of breathing. The supraglottic airway resistance was in the normal range and was significantly smaller than the endotracheal tube resistance (0.79 +/- 0.4 versus 1.43 +/- 0.31 cm H2O x s/L; p = 0.008, flow = 0.25 L/s). We conclude that a 2-h trial of spontaneous breathing through an endotracheal tube well mimics the work of breathing performed after extubation, in patients who pass a weaning trial and do not require reintubation.
在T型管试验期间气管内插管（ETT）的影响仍存在争议。我们的目的是比较14例成功拔管患者在2小时试验结束时（T）和气管拔管后（E）的呼吸功，并使用声反射法评估气管内插管和声门上气道的阻力及其相关功。我们发现患者在T和E时的呼吸功相同（分别为1.72±0.59与1.63±0.45 J/L；p = 0.50；以及23.5±10.6与22.6±9.7 J/min；p = 0.70）。T型管试验开始和结束时无显著差异（1.57±0.53与1.72±0.59 J/L，p = 0.10）。ETT导致的功占总呼吸功的11.0±3.9%。声门上气道阻力在正常范围内，且显著小于气管内插管阻力（0.79±0.4与1.43±0.31 cmH₂O·s/L；p = 0.008，流速 = 0.25 L/s）。我们得出结论，对于通过撤机试验且无需再次插管的患者，通过气管内插管进行2小时的自主呼吸试验能很好地模拟拔管后的呼吸功。
