Artículos de revistas
Atraumatic Endotracheal Tube For Mechanical Ventilation [tubo Endotraqueal Atraumático Para Ventilação Mecânica.]
Registro en:
Revista Brasileira De Anestesiologia. , v. 61, n. 3, p. 311 - 319, 2011.
347094
10.1016/S0034-7094(11)70037-X
2-s2.0-80052475593
Autor
Servin S.O.N.
Barreto G.
Martins L.C.
Moreira M.M.
Meirelles L.
Neto J.A.C.
Zen Junior J.H.
Tincani A.J.
Institución
Resumen
Background and objectives: Patients who need to stay under endotracheal intubation for long periods or when undergoing general anesthesia may develop tracheal lumen injuries due to pressure from distal cuff. In some cases, these injuries may evolve to stenosis or, occasionally, necrosis. The objective of this study was to present a modified endotracheal tube (METT) in which the cuff pressure is variable according to the cycle of mechanical ventilation (MV), which was tested on a lung simulator and animal model. Methods: Two models of endotracheal tubes, a modified (METT) and a conventional (CETT), number 7.5 mm and 8.0 mm, were connected to a lung simulator in a mechanical ventilator adjusted with two tidal volumes (TV) of 10 and 15 mL.kg -1 and a compliance of 60 mL.cmH 2O to evaluate the ventilatory efficiency of METT. Both models were also compared in Large-White pigs under general anesthesia and MV for 48 consecutive hours. Subsequently, animals were sacrificed for histopathological analysis of their tracheas. Results: Both METTs (#7.5 and 8.0) presented air leaks in lung simulator. The smallest air leak (13%) was observed in METT #7.5 with TV = 15 mL.kg -1, while the largest air leak (32%) was observed in METT #8.0 with TV = 10 mL.kg -1. Nevertheless, both METTs showed good efficiency on the lung simulator. In animals, on histopathological analysis of their tracheas, it was found that METT caused less trauma to the epithelium when compared to CETT. Conclusion: The use of a new model of ETT may decrease the risks of tracheal injury without hindering respiratory mechanics. © 2011 Elsevier Editora Ltda. 61 3 311 319 Sole, M.L., Penoyer, D.A., Su, X., Assessment of endotracheal cuff pressure by continuous monitoring: a pilot study (2009) Am J Crit Care, 18, pp. 133-143 Bain, J.A., Late complications of tracheostomy and prolonged endotracheal intubation (1972) Int Anesthesiol Clin, 10, pp. 225-244 Tornvall, S.S., Jackson, K.H., Oyanedel, E., Tracheal rupture, complication of cuffed endotracheal tube (1971) Chest, 59, pp. 237-239 Cooper, J.D., Grillo, H.C., Experimental production and prevention of injury due to cuffed tracheal tubes (1969) Surg Gynecol Obstet, 129, pp. 1235-1241 Bishop, M.J., Mechanisms of laryngotracheal injury following prolonged tracheal intubation (1989) Chest, 96, pp. 185-186 Yang, K.L., Tracheal stenosis after a brief intubation (1995) Anesth Analg, 80, pp. 625-627 McCulloch, T.M., Bishop, M.J., Complications of translaryngeal intubation (1991) Clin Chest Med, 12, pp. 507-521 Magovern, G.J., Shively, J.G., Fecht, D., The clinical and experimental evaluation of a controlled-pressure intratracheal cuff (1972) J Thorac Cardiovasc Surg, 64, pp. 747-756 Kamen, J.M., Wilkinson, C.J., A new low-pressure cuff for endotracheal tubes (1971) Anesthesiology, 34, pp. 482-485 Arola, M.K., Anttinen, J., Post-mortem findings of tracheal injury after cuffed intubation and tracheostomy. A clinical and histopathological study (1979) Acta Anaesthesiol Scand, 23, pp. 57-68 Conti, M., Pougeoise, M., Wurtz, A., Management of postintubation tracheobronchial ruptures (2006) Chest, 130, pp. 412-418 Lindholm, C.E., Experience with a new orotracheal tube (1973) Acta Otolaryngol (Stockh), 75, pp. 389-390 Nordin, U., Lindholm, C.E., Wolgast, M., Blood flow in the rabbit tracheal mucosa under normal conditions and under the influence of tracheal intubation (1977) Acta Anaesthesiol Scand, 21, pp. 81-94 Moro, E.T., Prevenção da aspiração pulmonar do conteúdo gástrico (2004) Rev Bras Anestesiol, 54, pp. 261-275 AARC (American Association for Respiratory Care) clinical practice guideline. Management of airway emergencies (1995) Respir Care, 40, pp. 749-760. , American Association for Respiratory Care Brichet, A., Verkindre, C., Dupont, J., Multidisciplinary approach to management of postintubation tracheal stenoses (1999) Eur Respir J, 13, pp. 888-893 Lindholm, C.E., Prolonged endotracheal intubation (1970) Acta Anaesthesiol Scand, (SUPPL. 33), pp. 1-131 Klainer, A.S., Turndorf, H., Wu, W.H., Surface alterations due to endotracheal intubation (1975) Am J Med, 58, pp. 674-683 Paegle, R.D., Ayres, S.M., Davis, S., Rapid tracheal injury by cuffed airways and healing with loss of ciliated epithelium (1973) Arch Surg, 106, pp. 31-34 Bryant, L.R., Trinkle, J.K., Dubilier, L., Reappraisal of tracheal injury from cuffed tracheostomy tubes. Experiments in dogs (1971) JAMA, 215, pp. 625-628 Valles, J., Artigas, A., Rello, J., Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia (1995) Ann Intern Med, 122, pp. 179-186