Estudo Comparativo das Pressões dos Balonetes de Tubos Traqueais Contendo ou Não Válvula Reguladora de Pressão de Lanz®
Comparative Study of Tracheal Tube Cuff Pressures with or without Lanz® Pressure Regulation System
Laís Helena Camacho Navarro, José Reinaldo Cerqueira Braz, André Kuhn Pletsch, Rosa Beatriz Amorim, Norma Sueli Pinheiro Módolo
Resumo
Justificativa e Objetivos - A hiperinsuflação do balonete do tubo traqueal, causada pela rápida passagem do óxido nitroso, pode causar lesões traqueais. O objetivo deste trabalho é comparar as pressões em balonetes de tubos traqueais, contendo ou não válvula reguladora da pressão, durante anestesia com óxido nitroso. Método - Foram medidas as pressões nos balonetes dos tubos traqueais de 40 pacientes adultos, estado físico ASA I e II, durante anestesia com óxido nitroso (60%) em oxigênio (40%), como segue: G1 (n = 20), pacientes intubados com tubos traqueais convencionais com balonetes de baixa pressão (Portex Blue-Line, Inglaterra); G2 (n = 20), pacientes intubados com tubos traqueais dotados de válvula reguladora de pressão de Lanz® (Mallinckrodt, EUA). Em ambos os grupos, a insuflação dos balonetes foi feita com ar, até a pressão de 25 cm H2O. A medida da pressão no balonete foi realizada através de manômetro (Mallinckrodt, EUA) antes e após 30, 60, 90 e 120 minutos do início da inalação de óxido nitroso. Resultados - Após a administração de óxido nitroso, as pressões nos balonetes dos tubos traqueais aumentaram somente em G1, ultrapassando o valor crítico de 30 cm H2O para o fluxo sangüíneo da mucosa traqueal, já aos 30 minutos do estudo. Em G2, as pressões nos balonetes diminuíram significativamente aos 30 minutos, permanecendo estáveis nos momentos seguintes, acima de 20 cm H2O (p < 0,002). Houve diferença significante entre os grupos em todos os tempos estudados (p < 0,0001). Conclusões - O tubo traqueal provido de válvula de Lanz® para redifusão de óxido nitroso impede que ocorra aumento da pressão no balonete durante anestesia. O uso sistemático desse tubo poderá diminuir a incidência de complicações traqueais, particularmente após cirurgias de longa duração e em Unidades de Terapia Intensiva.
Palavras-chave
Abstract
Background and Objectives - High tracheal tube cuff pressures determined by fast nitrous oxide transfer may induce tracheal injuries. This study aimed at comparing tracheal tube cuff pressures with or without a pressure regulation system during anesthesia with nitrous oxide. Methods - During anesthesia with 60% nitrous oxide and 40% oxygen, tracheal tube cuff pressures were measured in 40 adult patients, physical status ASA I or II, as follows: G1 (n = 20), tracheal intubation with conventional low pressure cuffed tubes (Portex Blue-Line, England); G2 (n = 20) tracheal intubation with tubes featuring a cuff pressure regulation system (Lanz® balloon) (Mallinckrodt, USA). Cuffs were inflated with air to a pressure of 25 cm H2O in both groups. Cuff pressure was measured with a manometer (Mallinckrodt, USA) before and at 30, 60, 90 and 120 minutes after nitrous oxide inhalation. Results - Cuff pressures progressively increased in G1 throughout the procedure, being at 30 minutes already above the critical value of 30 cm H2O for tracheal mucosal blood flow. In G2, cuff pressures significantly decreased at 30 minutes and remained stable above 20 cm H2O (p < 0.002). There have been significant differences between groups in all moments (p < 0.0001). Conclusions - Tracheal tube with a Lanz® balloon prevents cuff pressure increase during anesthesia. The systematic use of such tube may decrease the incidence of tracheal complications, especially after long duration surgeries and in Intensive Care Units.
Keywords
Referências
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