Perianesthesia emergency repair of a cut endotracheal tube’s inflatable tube:A case report

BACKGROUND During the perianesthesia period,emergency situations threatening the life and safety of patients can occur at any time.When dealing with some emergencies,occasional confusion is inevitable.CASE SUMMARY This case report describes the rare situation wherein a surgeon inadvertently detached the inflatable tube of an endotracheal tube during a tonsillectomy,and positive pressure ventilation could not be provided.While reintubation may increase the risk of respiratory tract infection and aspiration,patients with a difficult airway might die due to apnea.The best treatment method is to optimize the damaged tracheal tube junction to avoid secondary intubation and ensure patient safety.An intravenous needle and cannula were used to repair the damaged gap in the current case.Following the repair,the anesthesia machine showed no indication of low tidal volume,and there was no deflation of the endotracheal tube cuff.Subsequently,the patient was transferred to the postanesthesia recovery room,and the tracheal tube was removed with satisfactory results.CONCLUSION Using an intravenous needle to repair a break in the inflatable tube surrounding an endotracheal tube is safe and reliable.

Novel Formula for Calculation of the Optimal Insertion Depth for Cuffed Endotracheal Tubes in Pediatric Major Surgery

Background: Accurate determination of the optimal insertion depth of a pediatric endotracheal tube (ETT) is quite important. The aim of this study was to create an easily available formula that can be used to determine the optimal insertion depth for a cuffed ETT even without depth marking with clear definitions of the upper and lower limits for the tip of ETT in the trachea in clinical practice. Methods: Eighty children under 12 years of age were enrolled. The depth marking of the cuffed ETT was placed at the vocal cords and both lungs were then auscultated using a stethoscope. The upper limit was radiographically defined as the position of the tip of the cuffed ETT being between the clavicles. The lower limit was defined as a distance of 5 mm above the carina. The relationship between the insertion depth and patient characteristics was analyzed to create a formula for optimal ETT insertion depth. Results: Sixty-nine ETTs were optimally placed in the trachea. There were good correlations between the optimal insertion depth of ETTs and patients characteristics (height (R = 0.92);BSA (R = 0.92);weight (R = 0.91);age (R = 0.88)). Using these patient characteristics, we created the following three formulas for calculation of the optimal insertion depth for pediatric cuffed ETTs: insertion depth (cm) = height (cm)/11 + 5.5, weight (kg)/3 + 9.5 or 11 + 3/4 × age (years). The rates of appropriate tube placement of both pediatric cuffed ETTs were 87.5% (Hi-Contour) and 85.0% (Microcuff). Conclusions: Our formula and graphs may be easy to determine the optimal insertion depth of cuffed ETT even without depth marking in clinical practice.

National Survey of Attitudes and Practices of Endotracheal Tube Management in Infants and Small Children in Japan

Background: Surveys of pediatric endotracheal tube (ETT) management previously reported that specialists in pediatric anesthesia and intensive care medicine preferred to use uncuffed ETTs for children younger than 8 to 10 years of age. The aim of this study was to reveal the most recent attitudes and clinical practices of pediatric ETT management in Japan. Methods: The attitudes and clinical practices of pediatric ETT management were investigated using the data sheets of each institution and each patient. The data sheets contained information on patient characteristics and type of hospital, surgical procedures, devices used for intubation, and ETT information including types, size, depth, intracuff pressure (ICP), interval of ICP measurement, laryngeal packing, ETT exchange, airway complications, and reintubations. Results: The response rate of this survey was 66.7%. More than half of children older than 2 years of age were intubated with cuffed ETTs;83.5% of cuffed ETTs were used with the cuffs inflated, and ICP was measured in 80.7% of cuffed ETTs. More than half of ICP measurements were only taken at the time of intubation. Post-extubation stridor was rarely observed in cuffed (0.4%) or uncuffed ETTs (1.2%). The pediatric ETT management questionnaire revealed age-based size selection, differences in pressure of air leakage between cuffed (15 - 20 cmH2O) and uncuffed ETTs (20 - 30 cmH2O) of different sizes, the depthmarking method of insertion length. Continuous measurement of ICP was not common. Conclusion: This study revealed widespread use of cuffed ETTs in children older than 2 years of age, rarely occurrence of post-extubation stridor, inflation of cuffs, and practice of ICP measurement.

Estimation of Endotracheal Tube Cuff Pressure in a Large Teaching Hospital in Ghana

Background: Maintenance of optimal Endotracheal Tube cuff Pressure (ETTcP) in anaesthetic practice reduces cuff pressure complications. Aneroid manometers for measurement of ETTcP are not widely available in Ghana, hence anaesthesia providers estimate ETTcP according to their experience. The study assessed ETTcP obtained from estimation techniques between anaesthesia providers at Korle-Bu Teaching Hospital (KBTH). It also evaluated the Volume of Air Required (VAR) to obtain an acceptable cuff inflation pressure for sizes 7.0 and 8.0 mm adult endotracheal tubes used at the hospital, and the effect of patient’s age, weight and height on this volume. Methods: Eighty-one patients who underwent general anaesthesia were recruited. ETTcP was measured using an aneroid manometer via a three-way tap. After full cuff deflation, the cuff was refilled with air until an ETTcP of 20 cm H2O was obtained. Independent t-test was used to measure the statistical variations in the ETTcP using estimation techniques in relation to recommended levels as well as the significant difference of mean VAR to obtain a cuff pressure of 20 cm H2O. Grouped t-test was used to determine significant differences in ETTcP between anaesthesia providers using estimation techniques. Results: Mean ETTcP obtained from estimation techniques was (61.87, 73.79) cm H2O. The mean ETTcP measured for Physician and Nurse Anaesthetists were 65.36 cm H20 and 69.52 cm H2O respectively. The mean VAR to achieve an ETTcP of 20 cm H2O for endotracheal tube sizes 7.0 mm and 8.0 mm were 3.90 ± 1.13 mls and 4.55 ± 0.95 mls respectively. Age and weight significantly influenced the VAR to achieve a cuff pressure of 20 cm H2O, however, height did not. Conclusions: This study demonstrated that cuff pressures obtained by estimation techniques were generally higher than the recommended average with no significant difference between anaesthesia providers. However, in the absence of an aneroid manometer, ETTcP of tube sizes 7.0 mm and 8.0 mm can be safely approximated to the recommended levels with predetermined inflation volumes.

Should We Pay More Attention to Endotracheal Tube Fixation during Anesthesia—Surveys from Chinese Anesthesiologists for Endotracheal Tube Fixation and Endotracheal Tube Displacement in 2014 and 2020

Background: Displacement of endotracheal tube (ETT) can result in endobronchial intubation and accidental extubation that severely threatens safety of surgical patients. However, few surveys have investigated intraoperative ETT displacement experienced by anesthesiologists. The objective of these surveys was to investigate ETT fixation method and ETT displacement during general anesthesia experienced by anesthesiologists in China in 2014 and 2020. Methods: A questionnaire was designed with twenty questions and randomly distributed to anesthesiologists in two survey methods. In 2014, we collected responses from anesthesiologists who participated in the 22nd annual meeting of the Chinese Society of Anesthesiology in a face-to-face setting;in 2020, anesthesiologists from twenty-eight provinces completed the questionnaire through an online questionnaire survey platform. Differences in the responses from the anesthesiologists in 2014 and 2020 were assessed with a chi-square test. Results: In total, 568 questionnaires were collected, of which 541 questionnaires were valid (valid response rate 95.2%). A majority of the respondents (65.6%) had experienced ETT displacement, and 4.3% of respondents had experienced serious complications due to ETT displacement. Three hundred and twenty-nine respondents (60.8%) fixed the ETT with adhesive tape in the shape of the letter X. A majority of respondents considered the influence of surgical site, body position (97.8% of all respondents), and age (77.1% of all respondents) on fixing the ETT. Adhesive tape was the most commonly used material to fix the ETT (90.4% of the respondents). Conclusion: During clinical anesthesia, a majority of anesthesiologists experienced ETT displacement that can result in serious consequences. Therefore, the management of ETT should be a priority during the operation.

Endotracheal Tube Displacement during Cardiac Surgery in Infants: A Retrospective Cohort Study of Its Incidence and Predictors

Introduction: With the traction on the trachea and intrathoracic manipulation during cardiac surgery, the position of the endotracheal tube (ETT) might be changed as compared to before surgery. Migration of the ETT during pediatric cardiac surgery is particularly problematic in infants. Methods: In this retrospective cohort study, chest X-rays were taken in the operating room just before and after surgery. The position of the ETT among all infants under 1 year of age who underwent cardiac surgery between December 2017 to December 2019 was evaluated. The displacement of the ETT position was examined by measuring the position of the tube tip from the tracheal bifurcation on a chest X-ray, and the relationship between surgery-related factors (age, height, weight, sex, surgery time, cardiopulmonary bypass, tube size, use of tube cuff) was analyzed. Results: Eighty-eight of the 141 patients were enrolled. There was a significant proximal displacement of the ETT tip during cardiac surgery. The distance from the carina to the tube tip after surgery was long, on average 2.5 mm, compared to that before surgery (P = 0.013). Cephalad displacement of the ETT either ≥5 mm or ≥2.5 mm was found in 28 and in 38 out of 88 infants after surgery, respectively. After performing multivariate analysis, the use of un-cuffed ETT was the sole exploratory variable predictive of tube tip displacement (OR 0.34, 95% CI 0.10 - 0.93 if ≥5 mm;and OR 0.24, 95% CI 0.08 - 0.75 if ≥2.5 mm displacement;P = 0.04 and 0.01, respectively). Conclusion: Proximal displacement of the ETT during cardiac surgery occurs more frequently in infants with un-cuffed ETT.

A Comparison of Five Adhesive Tapes for Securing Endotracheal Tube in a Manikin

Background: Adhesive tape is the common method for endotracheal tube (ETT) secured to prevent tube displacement and unplanned extubation in an anesthesia setting. However, it is unclear which tape is superior for ETT fixation among the various tapes used in clinical practice. This study examines the force required to move 2 cm ETT and extubate ETT from an intubation manikin with five different adhesive tapes. Methods: We orally intubated an adult intubation manikin with an inner-diameter 7.5 mm ETT, inflated the cuff to 20 cm H2O. Then we secured ETT with five different adhesive tapes (Transpore tapeTM, Urgosyval tape®, TransporeTM White tape, Multipore tape, DuraporeTM tape) in a conventional fixation method. A digital force gauge was connected to the ETT and pulled in a direction erected to the oral cavity. We measured the force required to move 2 cm ETT and extubate ETT (defined as 5 cm ETT displacement) from the manikin. Data were analyzed with one-way analysis of variance, with P < 0.05. Results: DuraporeTM tape had the largest average force of 2 cm displacement (58.9 ± 5.7N) (P < 0.05). The extubation force of DuraporeTM tape (59.7 ± 4.9N) was larger than Urgosyval® tape (40.4 ± 2.9N) (P < 0.05), TransporeTM tape (48.7 ± 5.1N) (P < 0.05), Transpore WhiteTM tape (48.7 ± 5.1N) (P < 0.05). Conclusion: DuraporeTM tape was superior to the other four tapes (TransporeTM tape, Urgosyval® tape, TransporeTM white tape, Multipore tape) in holding the ETT in place in the manikin.

A Comparison of the Best Place to Fix Endotracheal Tubes for Men and Women When Men and Women Are in the Same Height

Background: Comparison of the tracheal tube depth over the same body height of men and women based upon intubation depth markings. Methods: Kashan University of Medical Sciences ethics committee approved the study and written informed consent was taken for each patient. Patients undergoing surgery requiring general anesthesia with oro-tracheal intubation were included in a prospective observational study. After induction of general anesthesia, the endotracheal tube was secured at the point at which the cuff was just below the vocal cord on laryngoscopy. Results: In a statistical study of 682 intubated patients which consisted of 499 women and 183 men, 28 cases of laryngoscopic view grade III and IV were excluded from the study. The measurement markings on the ETT at the level of right corner of the mouth were 20.65 ± 0.13 and 18.52 ± 0.08 for men and women respectively (CI 95%). Patient’s height has a meaningful correlation with the measurement of the fixation point of the ETT. Pearson correlation coefficient between the securing point of the tube and height was 0.2 and 0.357 for men and women respectively. In most cases of men and women of the same height, Mann-Whitney U test rejected the hypothesis that the tube can be fixed in the particular point. Conclusions: In general, men are taller than women. Comparing the fixation depth of the tube, even when man and woman have the same body height, the endotracheal tube might be placed in a deeper level for men rather than women.

Formation of granulation tissue on bilateral vocal cords after doublelumen endotracheal intubation:A case report

BACKGROUND Most case reports on laryngeal granuloma formation have described patients after tracheotomy and single-lumen endotracheal intubation.Few studies have investigated vocal cord granuloma formation after double-lumen endotracheal(DLT)intubation.CASE SUMMARY We report granulation tissue formation on the bilateral vocal cords after DLT intubation in a 45-year-old,153-cm-tall female patient.Previous imaging reports showed no formation of vocal cord granuloma before DLT intubation.Therefore,we inferred that DLT intubation may have been the main reason for the postoperative granulation tissue formation on her bilateral vocal cords,based on the patient’s history of DLT intubation,persistent hoarseness after thoracic surgery,and fibrolaryngoscopic and pathological reports during 12 mo follow-up.CONCLUSION Thirty-two Fr DLT tubes should be utilized for thoracic surgery on female patients who are shorter than 153 cm in height.

Evaluation and Management of Massive Endotracheal Hemorrhage in Pediatric Patients: A Case Report and Review of Literature

Massive hemoptysis is a frightening and life-threatening event in children. Prompt, aggressive evaluation and management are necessary. The most common cause of hemoptysis in a pediatric patient is infectious, but other various etiologies including tracheotomy related problems, cystic fibrosis, bronchiectasis, congenital anomalies of the cardiopulmonary vasculature and suction trauma must be considered as well. Presented is a report of a case of acute, massive endotracheal hemorrhage with multiple methods of management including balloon tamponade, highly selective embolization, and mainstem occlusion. This case is an addition to our previously reported case series of nine pediatric patients with massive pulmonary hemorrhage. Various diagnostic and management techniques of hemoptyis in pediatric patients are discussed with an extensive review of the literature.

Inter-Professional-Compassionate pain management during endotracheal suctioning: a valuable lesson from a Chinese surgical intensive care unit

Objective:To compare the effects of a pain management program and routine suctioning methods on the level of pain presence and agitation in Chinese adults admitted to the intensive care unit.To disseminate the results from the implementation of the evidence-informed pain management interventions for reducing pain presence and agitation during endotracheal tube suctioning(ETS)and translate the key finding to clinical nursing practice.Methods:A quasi-experimental study of a two-group post-test design was conducted in adults admitted after surgery to a surgical intensive care unit(SICU)of the Second Affiliated Hospital of Kunming Medical University,Yunnan,China in 2018.Fifty-two adults who met the study eligibility were included after consent,26 in each group.Patients in the control group received usual care while patients in the intervention group received interventions to reduce agitation and pain-related ETS.The impacts of the intervention on the level of pain presence and agitation were measured at 5 measuring time points using the Chinese versions of Critical-Care Pain Observation Tool(CPOT)and Richmond Agitation Sedation Scale(RASS).Results:The level of pain presence in the intervention group statistically significantly decreased during,immediately after,and 5 min after suctioning.The level of agitation in the intervention group significantly decreased during and immediately after suctioning.Conclusions:The findings provide support for the positive pain-relieving effects of the evidence-informed pain-related ETS management interventions when compared with the usual ETS practice.The study interventions were sufficiently effective and safe to maintain patent airway clean and patent as standardized suctioning and helps pain relief.So,evidence-based pain-related ETS management intervention is worthy of recommending to utilize in SICU patients as well as other patients who required suctioning.It is worth noting that integrating pre-emptive analgesia prescription and administration with non-pharmacological intervention plays a critical role in achieving pain relief.

Comparison of the Effectiveness of Marked Suction Tubes vs. Plain Suction Tubes in Pediatric Mechanically Ventilated Patients

Introduction: Endotracheal suction plays a crucial role in the management of mechanically ventilated patients. This study aims to evaluate the clinical effectiveness and safety of suction tubes with markings in mechanically ventilated pediatric patients. Materials and Methods: A randomized assignment was carried out on a cohort of 52 pediatric patients who underwent mechanical ventilation in the Pediatric Intensive Care Unit at the Third Affiliated Hospital of Sun Yat-sen University, covering the period from January 2022 to December 2022. These patients were divided into two groups: an improved group (n = 26) utilizing marked suction tubes, and a regular group (n = 26) employing conventional suction tubes. The objective of our study was to evaluate the clinical effectiveness of marked suction tubes. Results: The effects of the improved group on the vital signs of children undergoing mechanical ventilation were small and statistically significant compared with the regular group (p < 0.05). Additionally, the improved group exhibited a reduced frequency of sputum suction, shorter mechanical ventilation duration, and fewer days of hospitalization in the PICU compared to the regular group during the ventilation period. Notably, the difference in the duration of PICU hospitalization was statistically significant (p < 0.05). Moreover, the incidence of adverse reactions in the improved group was notably lower, with statistically significant differences observed in airway mucous membrane damage and irritating cough when compared to the regular group (p < 0.05). Conclusion: The utilization of marked suction tubes provides clinical nurses with clear guidance for performing suctioning with ease, efficiency and safety. Consequently, advocating for the widespread implementation of marked suction tubes in clinical practice is a commendable pursuit.

A Giant Granuloma of the Vocal Process after Double-Lumen Bronchial Catheter Insertion: A Rare Case Report and Literature Review

Background: Double-lumen endotracheal (DLT) is commonly used for one-lung ventilation and lung separation during thoracic surgery. There are case reports of medically induced laryngeal granulomas, mainly in patients after single-lumen endotracheal (SLT) tube intubation and tracheotomy, and giant granulomas of the vocal cords due to double-lumen bronchial tube insertion have rarely been reported. Case presentation: A 49-year-old female patient underwent single-port thoracoscopy after DLT intubation as well as a wedge resection of the lower lobe of the left lung, which caused giant vocal process granulomas (VPGs) postoperatively. Based on a retrospective analysis of the general condition, current medical history, past medical history, and visual laryngoscopic observation of the vocal folds tissue, which ruled out preoperative vocal fold granuloma formation, we hypothesized that double-lumen bronchial catheter intubation may have been the primary cause of her vocal fold granuloma formation. Conclusions: Giant granuloma of the vocal folds after DLT insertion is a rare postoperative complication;therefore, if DLT intubation is to be performed, the anesthesiologist should choose an appropriate intubation plan and deal with it promptly to avoid the risk factors to ensure that the patient’s perioperative period is safe and smooth. In addition, if postoperative complications are encountered, they should be followed up and observed on time.

超声下胸膜滑动征在婴幼儿气管导管位置调整中的应用价值

目的探讨利用超声观察胸膜滑动征调整不同年龄段婴幼儿气管导管位置的准确率及所需时间。方法选取郑州大学第三附属医院240例气管插管全麻手术患儿,年龄0~3岁,按照年龄分为<1岁和≥1岁2个年龄段,2个年龄段患儿根据随机数字表法分为超声组和听诊组,分别采用超声法和听诊法调整气管导管的位置,分析2种方法调整气管导管位置的准确率及所需时间。结果<1岁年龄段中,超声组调整气管导管位置的准确率及调整所需时间均优于听诊组(P<0.05)。1~3岁年龄段中,超声组调整气管导管位置的准确率优于听诊组(P<0.05),但调整位置所需时间与听诊组相比差异无统计学意义(P>0.05)。超声组不良反应发生率低于听诊组(P=0.031)。结论在对婴幼儿进行气管插管时,超声法调整气管导管位置比听诊法更准确,不良反应发生率更低,且在<1岁年龄段的患儿中用时更短。

特制双导管结构在使用换管器更换气管导管中的应用价值

目的:探讨特制双导管结构在使用换管器更换气管导管过程中的应用价值。方法:选取60例围麻醉期需要更换气管导管的患者为研究对象,根据使用换管器不同分为对照组和试验组,每组各30例。对照组采用常规气管导管换管;试验组采用特制双导管换管。比较两组患者换管指标[一次插管成功率、插管时间、换管器折痕发生率、术后24 h咽痛(VAS评分)、声嘶发生情况]、换管过程中血流动力学[平均动脉压(MAP)、心率(HR)]及不良事件发生情况。结果:试验组患者换管一次插管成功率高于对照组(P<0.05);插管时间短于对照组(P<0.05);换管器折痕发生率低于对照组(P<0.05)。术后24 h,试验组患者咽痛VAS评分低于对照组(P<0.05);两组患者声嘶发生率无统计学差异(P>0.05)。两组患者在换管过程的MAP、HR比较,差异无统计学意义(P>0.05),且均无低氧血症等不良事件发生。结论:特制双导管结构能提高换管器换管一次性成功率,减少换管时间和并发症的发生。

双腔气管插管患者术后咽喉痛的危险因素分析

【目的】探讨拔管力等因素是否是双腔气管插管术后咽喉痛的危险因素。【方法】这是一项随机对照试验的事后分析。本研究收集18~65岁,ASAI-Ⅲ级的双腔气管插管患者围术期资料,记录性别、年龄、吸烟史、导管直径、导管留置时间、舒芬太尼用量、是否使用氟比洛芬酯、是否拔管时呛咳等。拔管时使用测力计测量拔除导管所需的力。根据术后是否发生咽喉痛分为咽喉痛组和无咽喉痛组。对两组资料进行组间比较和多因素logistic回归分析,筛选术后咽喉痛的危险因素。使用ROC曲线预测危险因素的预测效应。【结果】最终纳入163例患者,拔管后30 min有74例(45.4%)患者发生术后咽喉痛,89例(54.6%)患者未发生术后咽喉痛。多因素logistic回归分析结果显示女性[OR95%CI=3.83(1.73,8.50),P=0.0001]和拔管力增大[OR95%CI=1.78(1.45,2.20),P<0.001]是术后咽喉痛的独立危险因素。拔管力预测术后咽喉痛的AUC曲线为0.773[95%CI(0.701,0.846),P<0.001];当约登指数为0.447时,拔管力的最佳临界点是13N。【结论】女性和拔管力是双腔气管插管全身麻醉术后咽喉痛的独立危险因素。

内镜喉罩对胃内镜黏膜下剥离术气道管理和术后恢复的影响

目的评价内镜喉罩用于胃内镜黏膜下剥离术(ESD)患者围术期气道管理和术后恢复的效果。方法选择择期行胃ESD的患者90例,男48例,女42例,年龄18~64岁,BMI 18~25 kg/m^(2),ASAⅠ或Ⅱ级。将患者随机分为两组:内镜喉罩组(E组)和气管插管组(C组),每组45例。麻醉诱导后E组行内镜喉罩通气,消化内镜从喉罩的内镜通道置入;C组则采取气管内插管通气,消化内镜经口置入。记录插管情况(插管成功时间、插管一次性成功例数)、消化内镜置入情况(消化内镜置入时间和退镜例数)、手术时间、拔管时间以及PACU停留时间。记录入室时(T_(0))、置入喉罩或气管插管后即刻(T_(1))、消化内镜置入时(T_(2))、内镜退出时(T_(3))、拔除喉罩或气管导管后即刻(T_(4))、离开PACU时(T_(5))的HR、MAP。记录T_(1)—T_(3)时的平均气道压和气道峰压。记录E组改变体位前后、手术结束时的气道密封压和内窥镜显露分级(EVGS)。记录不良反应发生情况以及麻醉科医师和消化内镜医师的满意度。结果与T_(0)时比较,T_(1)、T_(4)时两组HR和MAP明显升高(P<0.05)。与C组比较,E组置入喉罩成功时间、拔除喉罩时间及PACU停留时间明显缩短,T_(1)、T_(4)时HR和MAP明显降低,围拔管期呛咳以及术后咽痛、声嘶发生率明显降低(P<0.05)。两组插管或置入喉罩一次性成功率、消化内镜置入时间和退镜率差异无统计学意义。E组内镜喉罩的密封性和对位良好。结论内镜喉罩可缩短胃ESD患者的人工气道建立成功时间,对消化内镜操作不造成干扰,缩短拔管时间和PACU停留时间,加快患者术后恢复。

气管导管套囊不同放气方式对拔管期呛咳反应及血流动力学的影响

目的 探讨气管导管套囊不同放气方式对拔管期呛咳反应及血流动力学的影响。方法 选取90例择期气管插管全身麻醉手术患者作为研究对象,随机分为研究组和对照组,每组45例。研究组将气管导管套囊的气囊端经三通分别连接注射器和无液压力计,拔管前抽吸套囊,使套囊内压下降3 cmH_(2)O/s;对照组拔管时使用注射器一次性快速抽尽套囊内气体。记录2组患者拔管期呛咳反应发生率及严重程度,记录全麻诱导前(T_(0))、套囊放气前(T_(1))、放气后即刻(T_(2))、拔管后1 min(T_(3))、拔管后3 min(T_(4))、拔管后5 min(T_(5))时点的平均动脉压(MAP)、心率(HR),并记录2组患者不良反应发生情况。结果 2组患者拔管期呛咳反应的起始时刻均为气管导管套囊放气即刻;研究组患者呛咳反应发生率和严重程度均低于对照组,差异有统计学意义(P<0.05)。与对照组比较,研究组T_(2)~T_(4)时点MAP降低,T_(2)~T_(5)时点HR降低,差异有统计学意义(P<0.05)。研究组拔管后咽部不适发生率为6.67%,低于对照组的26.67%,差异有统计学意义(P<0.05);2组拔管后通气不足发生率比较,差异无统计学意义(P>0.05)。结论 以恒定速度缓慢降低气管导管套囊压力的方法可以降低呛咳发生率和严重程度,减少术后拔管并发症,稳定血流动力学,效果优于一次性快速抽尽套囊内气体法。

新型气管导管固定方法在全麻下侧卧位消化内镜治疗中的应用

目的探讨在消化内镜治疗手术中,新型气管导管固定方法在侧卧位气管插管中的可靠性及安全性。方法选取2022年3~8月在南京大学医学院附属鼓楼医院消化内镜中心实施全麻下内镜治疗的患者80例,其中男44例,女36例,年龄20~45岁,体质量50~76 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法将患者分为对照组(n=40)和观察组(n=40)。对照组采用传统医用胶布固定气管导管,将胶布固定上侧面颊,呈“>”型,并在胶布上贴上3M透明贴膜;观察组采用新型气管导管固定方法固定导管,观察和比较两种固定方法的临床效果。结果观察组患者气管导管位移发生率5.0%,口腔、嘴角及面部皮肤损伤发生率6.7%,均低于对照组,差异具有统计学意义(P<0.05)。观察组患者在舒适度评分<3分占比72.5%,<6分占比97.5%,均低于对照组,差异具有统计学意义(P<0.05)。结论在侧卧位状态下经口内镜治疗的患者,使用新型气管导管固定方法可以明显降低气管导管位移度和脱管率,并可降低相关不良反应的发生率。操作简单快捷、取材方便、安全可靠,可以在临床上常规使用。

可微调气管套管封堵器结合康复治疗对重症气管切开患者呼吸及言语功能的疗效观察

目的:观察一种新式气管套管封堵用具——可微调气管套管封堵器,联合康复训练对重症气管切开患者呼吸及言语功能的应用效果。方法:共观察30例重症医学科康复治疗患者,按随机数字表分为试验组和对照组各15例。两组患者均接受重症临床和康复治疗,包括肺康复、吞咽与发声训练及运动疗法等,试验组患者在康复治疗期间佩戴可微调气管套管封堵器。两组患者的康复治疗时间均为每日2次,连续2周。治疗2周后,采用临床肺部感染评分(clinical pulmonary infection score,CPIS)、半定量咳嗽强度评分(semi-quantitative cough strength score,SCSS)、最长发声时间(maximum phonation time,MPT)与音量和气管套管拔管率等观察指标对两组患者进行比较。结果:经治疗两组患者的CPIS评分、SCSS评分、MPT与最高音量值均有明显变化(P<0.001)。其中,试验组患者SCSS得分同对照组比有显著性差异(P<0.05)。试验组MPT与最高音量值均高于对照组(P<0.05)。试验组患者气管套管拔管率高于对照组。结论:可微调气管套管封堵器联合康复治疗安全有效,对于改善重症气管切开患者呼吸及言语功能有积极意义。