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首页> 外文期刊>Journal of anesthesia >An endotracheal tube providing 'pressurized sealing' prevents fluid leakage in mechanically ventilated critically ill patients: a pilot study
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An endotracheal tube providing 'pressurized sealing' prevents fluid leakage in mechanically ventilated critically ill patients: a pilot study

机译：提供“加压密封”的气管内膜可防止机械通风的危重患者的流体泄漏：试点研究

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Microaspiration of bacteriologically contaminated oropharyngeal secretions alongside the cuff of an endotracheal tube (ETT) is a key mechanism for development of ventilator-associated pneumonia. We have constructed a prototype double-cuffed ETT equipped with a supplemental port in-between the cuffs through which continuous positive airway pressure (CPAP) is delivered. Pressure in the intercuff space propels secretions upwards and produces 100% tracheal sealing in an in vitro model. We conducted a 24 h study to investigate the sealing effect of this ETT in 12 critically ill mechanically ventilated patients. Methylene blue, instilled through a bronchoscope on top of the proximal cuff, was used as leakage tracer. Fiberoptic visualisation of the trachea was performed 1 h and 24 h thereafter. Leakage was confirmed if blue dye was detected on the tracheal mucosa beyond the tip of the ETT. In no patient, dye passed by the cuffs during the study period. Presence of the ETT did not interfere with ventilator settings, patient mobilization, physiotherapy, and technical acts. Overall, pressures in the intercuff space remained between 10 and 15 cmH(2)O. Excessive pressure swings were swiftly corrected by the CPAP system. A double-cuffed ETT, offering "pressurized sealing" of the trachea, safely and effectively prevented leakage during 24 h mechanical ventilation.
机译：与气管内管（ETT）的袖口侧面的细菌学上污染的口咽分泌物的微痉挛是呼吸机相关肺炎的开发的关键机制。我们构建了配备有袖口之间的补充口的原型双箍ETT，通过该袖口通过该袖口（CPAP）延伸。颈间空间中的压力向上填充分泌物，并在体外模型中产生100％气管密封。我们进行了一项24小时的研究，以调查12个批判性机械通风患者的IET的密封效果。亚甲基蓝色，滴落在近端袖口顶部的支气管镜，用作泄漏示踪剂。此后，在1小时和24小时进行气管的光纤可视化。如果在气管粘膜上检测到欧特尖端的气管粘膜上检测到蓝色染料，则确认泄漏。在没有患者的情况下，在研究期间被袖口通过染料。 ETT的存在并没有干扰呼吸机设置，患者动员，物理治疗和技术行为。总体而言，颈间空间中的压力保持在10到15 cmh（2）o之间。 CPAP系统迅速校正过大的压力波动。双重吊带的ETT，在24小时机械通风期间，安全有效地防止了气管的“加压密封”。

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