Campos C, Naguib S S, Chuang A Z, Lemak N A, Khalil S N
Department of Anesthesiology, The University of Texas Medical School at Houston, USA.
Anesth Analg. 1999 Feb;88(2):268-70. doi: 10.1097/00000539-199902000-00008.
Our purpose was to determine whether endobronchial intubation always causes an immediate increase in peak inflation pressure and, if so, the magnitude of the increase. Fourteen children scheduled for central line placement for prolonged antibiotic administration comprised the study group. After routine premedication and induction of anesthesia (halothane in oxygen), an endotracheal tube was inserted, and its position was verified by auscultation and fluoroscopy. Children were mechanically ventilated using a preset volume pressure-limited ventilator with a 5-L fresh gas flow. All children received a constant tidal volume using a similar circuit, similar tubing, and a similar compression volume. The lowest peak inflation pressure to deliver a tidal volume of 15 mL/kg was used. After adjusting the respiratory rate (end-tidal CO2 30 mm Hg) and anesthetic level (halothane end-tidal 1.2%), the peak inflation pressure at this endotracheal position was recorded. The endotracheal tube was advanced into a bronchus, the position was verified as above, and peak inflation pressure was recorded. The endobronchial tube was then pulled back into the trachea, and placement of the central line proceeded. The peak inflation pressure at the endobronchial position was significantly greater than the peak inflation pressure at the endotracheal position (P < 0.0001). The increase was instantaneous at the endobronchial position. Monitoring peak inflation pressure while inserting an endotracheal tube and during anesthesia can help to diagnose endobronchial intubation.
Monitoring peak inflation pressure while inserting an endotracheal tube and during anesthesia can help to diagnose endobronchial intubation.
我们的目的是确定支气管内插管是否总是会立即导致峰值充气压力升高，如果是，升高的幅度是多少。计划接受长期抗生素治疗并进行中心静脉置管的14名儿童组成了研究组。在进行常规术前用药和麻醉诱导（氧气中加入氟烷）后，插入气管内导管，并通过听诊和荧光透视确认其位置。使用预设容量压力限制呼吸机和5升新鲜气流对儿童进行机械通气。所有儿童使用相似的回路、相似的管道和相似的压缩容量接受恒定潮气量。使用输送15 mL/kg潮气量时的最低峰值充气压力。在调整呼吸频率（呼气末二氧化碳分压30 mmHg）和麻醉深度（呼气末氟烷浓度1.2%）后，记录该气管内位置的峰值充气压力。将气管内导管推进到支气管内，按上述方法确认位置，并记录峰值充气压力。然后将支气管内导管拉回到气管内，接着进行中心静脉置管。支气管内位置的峰值充气压力显著高于气管内位置的峰值充气压力（P < 0.0001）。在支气管内位置时压力升高是瞬间的。在插入气管内导管和麻醉期间监测峰值充气压力有助于诊断支气管内插管。
在插入气管内导管和麻醉期间监测峰值充气压力有助于诊断支气管内插管。
