高压氧舱内机械通气患者人工气道气囊压管理现状调查

Survey on the management of artificial airway cuff pressure in patients receiving mechanical ventilation in hyperbaric oxygen chamber

目的调查国内高压氧舱内机械通气患者人工气道气囊压的管理现状。方法2021年11-12月,使用自制电子调查问卷,以国内15家开展高压氧舱内机械通气治疗医院的高压氧科医护人员为调查对象,对科室及医护人员的一般情况、气囊压实际控制情况、气囊压控制方法满意度及更换意愿进行调查。结果“三甲”医院占所有调查医院的86.7%,高压氧舱内机械通气患者的治疗频率为(25.9±39.5)人次/年;医护人员高压氧从业年限为(14.9±7.49)年;被调查科室均要求控制气囊压,且有气囊压相关管理制度;进行气囊压监测定期培训及考核的科室占53.3%;具有气囊压监测专用设备的科室占46.7%;采用指触法估计气囊压者占63.4%,将舱内气囊压控制在25~30 cmH2O者占19.5%,其他范围者占17.1%;满意度从高到低依次为气囊压自动控制仪、气囊测压表、注射器充放气和替换等体积生理盐水;采用替换等体积生理盐水法的医护人员均有更换意愿,气囊压自动控制仪使用者均不愿更换。结论15家医院高压氧舱内机械通气治疗开展并不均衡,气囊压监测专用设备在高压氧科普及率不高,气囊压自动控制仪在高压氧舱内使用的满意度相对较高,高压氧舱内气囊压监测及控制方法仍需改进和规范。

Objective To investigate the current status of management of artificial airway cuff pressure in patients receiving mechanical ventilation in hyperbaric oxygen chamber in China.Methods From November to December in 2021,a self-developed electronic questionnaire was employed to investigate medical staff in the Department of Hyperbaric Oxygen.The survey was conducted among medical staff from 15 Chinese hospitals that provided mechanical ventilation in hyperbaric oxygen chamber.This study focused on four aspects:the general data of the department and medical staff,the actual status of cuff pressure control,the satisfaction levels of medical staff regarding cuff pressure control methods,and their willingness to change the methods.Results Grade-A tertiary hospitals accounted for 86.7%among the surveyed hospitals.The treatment times of mechanical ventilation in hyperbaric oxygen chamber was(25.9±39.5)cases per year.The average working years of service in hyperbaric oxygen department of the medical staff were(14.9±7.49)years.All the surveyed departments had the requirements of cuff pressure control and had regulatory regime related to cuff pressure.The departments carrying out regular training and assessments on cuff pressure monitoring accounted for 53.3%.The departments that had specialized equipment for cuff pressure monitoring accounted for 46.7%.The medical staff estimating the cuff pressure by finger touch accounted for 63.4%.The cuff pressure inside chamber being maintained within the range of 25-30 cmH2O accounted for 19.5%,while the pressure being maintained within other ranges accounted for 17.1%.The satisfaction levels with different cuff pressure control methods ranked from high to low as follows:automatic cuff pressure controller,cuff pressure gauge,syringe inflation and deflation method,and replacement with equal volume saline.The medical staff who used the replacement with saline method all expressed a willingness to change the method,while the users of the automatic cuff pressure controller were all unwilling to change.Conclusion The application of mechanical ventilation in hyperbaric oxygen chamber is uneven among the 15 hospitals.The popularity of specialized equipment for monitoring cuff pressure in hyperbaric oxygen department is low.The satisfaction level of using automatic cuff pressure controller in hyperbaric oxygen chamber is relatively high.There is still a need to improve and standardize the methods for monitoring and controlling cuff pressure in hyperbaric oxygen chamber.