气管插管患儿围术期套囊压力管理研究现状杨

doi:10.3877/cma.j.issn.1673-5250.2023.02.002

气管插管术(endotracheal intubation)是目前临床管理儿童呼吸道最可靠的技术，其中气管导管套囊压力管理，作为呼吸道管理的重要组成部分，尚未引起临床麻醉科医师的足够重视，尤其在围术期全身麻醉及接受机械通气治疗重症患儿中。气管导管套囊充气的目的，主要保证围术期及机械通气治疗患儿有效通气和密封气管，气管导管套囊充气不足，除引起患儿通气量下降外，还存在导致患儿误吸的风险；相反，过度充气，则可导致患儿气管黏膜缺血、坏死，严重者甚至危及患儿生命安全。目前，国内外推荐成年患者气管导管套囊压力为20~30 cmH₂O(1 cmH₂O＝0.098 1 kPa)，然而由于医学伦理学限制，涉及患儿生理、解剖等特殊性，多数对于气管导管套囊压力数据的研究结果，均来源于成年患者。笔者拟对患儿围术期带套囊与无套囊气管导管的应用、气管导管套囊充气技术、气管导管套囊压力的影响因素、套囊压力变化，对术后患儿呼吸道并发症影响的最新研究现状进行阐述，旨在为提高患儿临床麻醉及机械通气治疗质量提供客观证据。

关键词: 插管法，气管内, 气道管理, 套囊压力监测, 麻醉，全身, 机械通气, 呼吸道黏膜损伤, 儿童

Endotracheal intubation is one of the most important techniques to manage airway in pediatrics. However, the variations of endotracheal cuff pressure were rarely noticed by anesthesiologists, especially intubated critically ill children. The aim of endotracheal cuff inflation is to maintain occlusion of airway and effectiveness of ventilation. Insufficient cuff inflation can lead to aspiration and inadequate ventilation. And overinflation of cuff causes ischemia and necrosis of tracheal mucosa yet. According to previous guidelines, the recommending endotracheal cuff pressure was 20-30 cmH₂O(1 cmH₂O=0.098 1 kPa) in adults. However, up to now researches on appropriate cuff pressure were limited in children due to ethical problem as well as their characteristics of physiology and anatomy. This article reviews current evidence of different endotracheal tube types, inflation technology, influencing factors of cuff pressure, and postoperative intubated-associated complications in children with the aim of providing the evidence for improving the quality of mechanical ventilation and clinical techniques in children.

Key words: Intubation, intratracheal, Airway management, Cuff pressure monitoring, Anesthesia, general, Mechanical ventilation, Respiratory mucosa injury, Child

[1]	Kumar CM, Seet E, Van Zundert T. Measuring endotracheal tube intracuff pressure: no room for complacency[J]. J Clin Monit Comput, 2021, 35(1): 3-10. DOI: 10.1007/s10877-020-00501-2.
[2]	Herbinger LA. Evidence based use of cuffed endotracheal tubes in children[J]. J Perianesth Nurs, 2018, 33(5): 590-600. DOI: 10.1016/j.jopan.2017.07.001.
[3]	Park S, Shin SW, Kim HJ, et al. Choice of the correct size of endotracheal tube in pediatric patients[J]. Anesth Pain Med (Seoul), 2022, 17(4): 352-360. DOI: 10.17085/apm.22215.
[4]	Holzki J, Brown KA, Carroll RG, et al.The anatomy of the pediatric airway: Has our knowledge changed in 120 years? A review of historic and recent investigations of the anatomy of the pediatric larynx[J]. Paediatr Anaesth, 2018, 28(1): 13-22. DOI：10.1111/pan.13281.
[5]	Thomas RE, Rao SC, Minutillo C, et al. Cuffed endotracheal tubes in infants less than 3 kg: a retrospective cohort study[J]. Paediatr Anaesth, 2018, 28(3): 204-209. DOI: 10.1111/pan.13311.
[6]	吴玉立，刘金柱，喻文立. 带套囊气管导管在小儿全身麻醉扁桃体射频消融术中的应用[J]. 中国现代医学杂志，2019, 29(9): 75-78. DOI: 10.3969/j.issn.1005-8982.2019.09.016.
[7]	李响. 气管导管套囊压力术中管理的研究进展[J]. 临床与病理杂志，2021, 41(4): 955-959. DOI: 10.3978/j.issn.2095-6959.2021.04.035.
[8]	Ferenczy ED, Stoner MJ, Spencer SP, et al. Elevated endotracheal tube cuff pressure in the pediatric emergency department[J]. Int J Pediatr Otorhinolaryngol, 2018, 113: 289-291. DOI: 10.1016/j.ijporl.2018.08.008.
[9]	Ilczak T, Cwiertnia M, Bialon P, et al. Endotracheal tube cuff pressure-comparison of the two filling methods-simulated test[J]. Prehosp Disaster Med, 2021, 36(4): 421-425. DOI: 10.1017/S1049023X21000406.
[10]	Laksono BH, Isngadi I, Wicaksono SJ. Passive release technique produces the most accurate endotracheal tube cuff pressure than manual palpation and minimum occlusive volume technique in the absence of manometer[J]. Turk J Anaesthesiol Reanim, 2021, 49(2): 114-117. DOI: 10.5152/TJAR.2020.80.
[11]	Tsaousi GG, Pourzitaki C, Chlorou D, et al. Benchmarking the applicability of four methods of endotracheal tube cuff inflation for optimal sealing: a randomized trial[J]. J Perianesth Nurs, 2018, 33(2): 129-137. DOI: 10.1016/j.jopan.2016.09.002.
[12]	Nazari R, Boyle C, Panjoo M, et al. The changes of endotracheal tube cuff pressure during manual and intermittent controlling in intensive care units[J]. Iran J Nurs Midwifery Res, 2020, 25(1): 71-75. DOI：10.4103/ijnmr.IJNMR_55_19.
[13]	Wang WZ, Zhou YY, Wang ZJ, et al. A mobile terminal application program was used for endotracheal tube cuff pressure measurement[J]. J Clin Monit Comput, 2021, 35(3): 463-468. DOI：10.1007/s10877-020-00499-7.
[14]	Nseir S, Zerimech F, Fournier C, et al. Continuous control of tracheal cuff pressure and microaspiration of gastric contents in critically ill patients[J]. Am J Respir Crit Care Med, 2011, 184(9): 1041-1047. DOI：10.1164/rccm.201104-0630OC.
[15]	Dauvergne JE, Geffray AL, Asehnoune K, et al. Automatic regulation of the endotracheal tube cuff pressure with a portable elastomeric device. A randomised controlled study[J]. Anaesth Crit Care Pain Med, 2020, 39(3): 435-441. DOI: 10.1016/j.accpm.2020.04.007.
[16]	王金保，张在旺，汤龙信，等. 不同气管导管套囊压力对颈部手术后患者咽部症状的影响[J]. 临床误诊误治，2018, 31(10): 74-78. DOI: 10.3969/j.issn.1002-3429.2018.10.020.
[17]	De Pascale G, Pennisi MA, Vallecoccia MS, et al. CO₂ driven endotracheal tube cuff control in critically ill patients: a randomized controlled study[J]. PLoS One, 2017, 12(5): e175476. DOI: 10.1371/journal.pone.0175476.
[18]	Bhardwaj M, Kaur K, Sharma A, et al. Comparison of three different techniques of endotracheal tube cuff inflation: just seal, stethoscope guided and pressure volume loop: a prospective randomized study[J]. Int J Res Med Sci, 2020, 8(2): 512. DOI: 10.18203/2320-6012.ijrms20200227.
[19]	赵桂华，翟晶雯，徐江叶，等. 全麻患者气管插管套囊压力和术后气道并发症的现况调查及影响因素分析[J]. 临床麻醉学杂志，2018, 34(8): 733-738. DOI: 10.12089/jca.2018.08.001.
[20]	Rosero EB, Ozayar E, Eslava-Schmalbach J, et al. Effects of increasing airway pressures on the pressure of the endotracheal tube cuff during pelvic laparoscopic surgery[J]. Anesth Analg, 2018, 127(1): 120-125. DOI: 10.1213/ANE.0000000000002657.
[21]	Giusti GD, Rogari C, Gili A, et al. Cuff pressure monitoring by manual palpation in intubated patients: how accurate is it? A manikin simulation study[J]. Aust Crit Care, 2017, 30(4): 234-238. DOI: 10.1016/j.aucc.2016.10.001.
[22]	Kako H, Krishna SG, Ramesh AS, et al. The relationship between head and neck position and endotracheal tube intracuff pressure in the pediatric population[J]. Paediatr Anaesth, 2014, 24(3): 316-321. DOI: 10.1111/pan.12308.
[23]	Kara H, Hundur D, Doruk C, et al. The changes of endotracheal tube intracuff pressures after ear and head and neck surgery-related positions: a prospective observational study[J]. Braz J Otorhinolaryngol, 2022, 88(1): 46-52. DOI: 10.1016/j.bjorl.2020.05.005.
[24]	Canpolat DG, Cantekin K, Bayram A, et al. The effect of mouth prop on endotracheal tube intracuff pressure in children during dental rehabilitation under general anaesthesia[J]. J Clin Monit Comput, 2018, 32(1): 141-145. DOI: 10.1007/s10877-016-9972-z.
[25]	Maddali MM, Al HT, Sathiya PM, et al. The effect of intraoperative transesophageal echocardiography probe placement on the endotracheal tube cuff pressure in adult patients undergoing on-pump cardiac surgery[J]. J Cardiothorac Vasc Anesth, 2022, 36(8 Pt B): 3084-3089. DOI: 10.1053/j.jvca.2022.02.037.
[26]	屈启才，胡平，白忠，等. 支撑喉镜手术的体位对气管导管套囊压力的影响研究[J]. 重庆医学，2018, 47(25): 3311-3312. DOI: 10.3969/j.issn.1671-8348.2018.25.017.
[27]	Mogal SS, Baliarsing L, Dias R, et al. Comparison of endotracheal tube cuff pressure changes using air versus nitrous oxide in anesthetic gases during laparoscopic abdominal surgeries[J]. Braz J Anesthesiol, 2018, 68(4): 369-374. DOI: 10.1016/j.bjan.2018.01.011.
[28]	Nseir S, Brisson H, Marquette CH, et al. Variations in endotracheal cuff pressure in intubated critically ill patients: prevalence and risk factors[J]. Eur J Anaesthesiol, 2009, 26(3): 229-234. DOI: 10.1097/eja.0b013e3283222b6e.
[29]	Delorenzo A, Shepherd M, Andrew E, et al. Endotracheal tube intracuff pressure changes in patients transported by a helicopter emergency medical service: a prospective observational studys[J]. Air Med J, 2021, 40(4): 216-219. DOI：10.1016/j.amj.2021.04.002.
[30]	Armstrong J, Jenner P, Poulose S, et al. The effect of saline versus air for cuff inflation on the incidence of high intra-cuff pressure in paediatric MicroCuff((R)) tracheal tubes: a randomised controlled trial[J]. Anaesthesia, 2021, 76(11): 1504-1510. DOI: 10.1111/anae.15493.
[31]	Sultan P, Carvalho B, Rose BO, et al. Endotracheal tube cuff pressure monitoring: a review of the evidence[J]. J Perioper Pract, 2011, 21(11): 379-386. DOI: 10.1177/175045891102101103.
[32]	Liu J, Zhang X, Gong W, et al. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study[J]. Anesth Analg, 2010, 111(5): 1133-1137. DOI: 10.1213/ANE.0b013e3181f2ecc7.
[33]	Ganason N, Sivanaser V, Liu CY, et al. Post-operative sore throat: comparing the monitored endotracheal tube cuff pressure and pilot balloon palpation methods[J]. Malays J Med Sci, 2019, 26(5): 132-138. DOI: 10.21315/mjms2019.26.5.12.
[34]	Mogyoródi B, Skultéti D, Mezócsáti M, et al. Effect of an educational intervention on compliance with care bundle items to prevent ventilator-associated pneumonia[J]. Intensive Crit Care Nurs, 2023, 75: 103342. DOI: 10.1016/j.iccn.2022.103342.

[1]	张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1068-1073.
[2]	张宝富, 俞劲, 叶菁菁, 俞建根, 马晓辉, 刘喜旺. 先天性原发隔异位型肺静脉异位引流的超声心动图诊断[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1074-1080.
[3]	韩丹, 王婷, 肖欢, 朱丽容, 陈镜宇, 唐毅. 超声造影与增强CT对儿童肝脏良恶性病变诊断价值的对比分析[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 939-944.
[4]	刘婷婷, 林妍冰, 汪珊, 陈幕荣, 唐子鉴, 代东伶, 夏焙. 超声衰减参数成像评价儿童代谢相关脂肪性肝病的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 787-794.
[5]	周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 795-800.
[6]	罗晨, 宗开灿, 李世颖, 傅应亚. 微小RNA-199a-3p调控CD4^＋T细胞表达参与肺炎支原体肺炎患儿免疫反应研究[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 569-574.
[7]	米洁, 陈晨, 李佳玲, 裴海娜, 张恒博, 李飞, 李东杰. 儿童头面部外伤特点分析[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 511-515.
[8]	中华医学会烧伤外科学分会小儿烧伤学组. 儿童烧伤早期休克液体复苏专家共识(2023版)[J]. 中华损伤与修复杂志(电子版), 2023, 18(05): 371-376.
[9]	王蕾, 王少华, 牛海珍, 尹腾飞. 儿童腹股沟疝围手术期风险预警干预[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 768-772.
[10]	李芳, 许瑞, 李洋洋, 石秀全. 循证医学理念在儿童腹股沟疝患者中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 782-786.
[11]	吕垒, 冯啸, 何凯明, 曾凯宁, 杨卿, 吕海金, 易慧敏, 易述红, 杨扬, 傅斌生. 改良金氏评分在儿童肝豆状核变性急性肝衰竭肝移植手术时机评估中价值并文献复习[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 661-668.
[12]	卓少宏, 林秀玲, 周翠梅, 熊卫莲, 马兴灶. CD64指数、SAA/CRP、PCT联合检测在小儿消化道感染性疾病鉴别诊断中的应用[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 505-509.
[13]	刘笑笑, 张小杉, 刘群, 马岚, 段莎莎, 施依璐, 张敏洁, 王雅晳. 中国学龄前儿童先天性心脏病流行病学研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1021-1024.
[14]	李静, 张玲玲, 邢伟. 兴趣诱导理念用于小儿手术麻醉诱导前的价值及其对家属满意度的影响[J]. 中华临床医师杂志(电子版), 2023, 17(07): 812-817.
[15]	余林阳, 王美英, 李建斌, 楼骁斌, 谢思远, 马志忠, 齐海英, 李稼. 高原地区肺炎合并右心功能衰竭体征患儿的肺动脉压力和心脏形态与功能的特征[J]. 中华临床医师杂志(电子版), 2023, 17(05): 535-544.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Current research status on perioperative cuff pressure management in children with endotracheal intubation

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Current research status on perioperative cuff pressure management in children with endotracheal intubation