Valentino J, Myers R K, Baker M D, Woodring J H
Division of Otolaryngology, University of Kentucky Chandler Medical Center, Lexington 40536-0084, USA.
Otolaryngol Head Neck Surg. 1999 Jan;120(1):51-6. doi: 10.1016/S0194-5998(99)70369-4.
Increased endotracheal tube cuff pressure causes mucosal ischemia that can lead to necrosis, infection, and, eventually, tracheomalacia or tracheal stenosis. Endotracheally intubated patients frequently undergo portable chest radiography. In this study we explored the relationship of endotracheal tube cuff pressure and the appearance on the tracheal air columns on the portable chest radiograph. We measured the endotracheal tube cuff pressure of intensive care unit patients 124 times immediately before portable chest radiography. On 64 of these radiographs we measured the width of the tracheal air column below the tip of the endotracheal tube and at the maximal diameter of the endotracheal tube balloon. We then analyzed the relationship of cuff pressure to tracheal dilation. The results of ANOVA of tracheal dilation for three groups (safe, borderline, and unsafe cuff pressures) were significant. Large overlapping ranges existed in each group. Regression analysis confirmed a linear relationship between cuff pressure and tracheal dilation (r = 0.435, p < 0.001). Predicted tracheal expansion at 20 mm Hg was a poor screen for endotracheal tube cuff inflation safety; the sensitivity was only 56% and specificity only 71%. The differences in the capacity for tracheal distension between patients make these findings not unexpected. The portable chest radiograph is a poor screening tool for unsafe endotracheal tube cuff pressure.
气管内插管套囊压力升高会导致黏膜缺血，进而引发坏死、感染，并最终导致气管软化或气管狭窄。气管插管患者经常需要进行床边胸部X线摄影。在本研究中，我们探讨了气管内插管套囊压力与床边胸部X线片上气管气柱表现之间的关系。我们在床边胸部X线摄影前立即对重症监护病房患者的气管内插管套囊压力进行了124次测量。在其中64张X线片上，我们测量了气管内插管尖端下方以及气管内插管气囊最大直径处的气管气柱宽度。然后我们分析了套囊压力与气管扩张之间的关系。对三组（安全、临界和不安全套囊压力）气管扩张情况的方差分析结果具有显著性。每组中都存在较大的重叠范围。回归分析证实套囊压力与气管扩张之间存在线性关系（r = 0.435，p < 0.001）。以20 mmHg时预测的气管扩张情况作为气管内插管套囊充气安全性的筛查指标效果不佳；敏感性仅为56%，特异性仅为71%。患者之间气管扩张能力的差异使得这些结果并不意外。床边胸部X线片对于不安全的气管内插管套囊压力来说是一种较差的筛查工具。
