Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942003000600004
Brazilian Journal of Anesthesiology
Scientific Article

Estudo das pressões no interior dos balonetes de tubos traqueais

Study of tracheal tube intra-cuff pressure

André Galante Alencar Aranha; Vicente Forte; João Aléssio Juliano Perfeito; Luiz Eduardo Villaça Leão; Carlos Jogi Imaeda; Yara Juliano

http://dx.doi.org/10.1590/S0034-70942003000600004 Braz J Anesthesiol, vol.53, n6, p.728-736, 2003
PDF
Downloads: 0
Views: 870

Resumo

JUSTIFICATIVA E OBJETIVOS: Como não é rotineiro o controle da pressão no interior dos balonetes de tubos traqueais, e não há descrição detalhada na literatura de como mantê-la abaixo dos 30 cmH2O sem utilização de manômetro, decidiu-se verificar as pressões no interior de balonetes de tubos traqueais em pacientes sob intubação traqueal na unidade de terapia intensiva e no cento cirúrgico, testando manobra para manter a pressão no balonete abaixo de 30 cmH2O, mas em níveis mínimos necessários para ciclagem do ventilador sem perda do volume corrente. MÉTODO: Foram estudadas as pressões no interior de balonetes de tubos traqueais de 50 pacientes sob intubação traqueal na unidade de terapia intensiva (Grupo I) e 72 pacientes sob intubação traqueal no centro cirúrgico (Grupo II). Testou-se uma manobra para obter a pressão mínima no interior do balonete do tubo traqueal, necessária para adequada ventilação, sem vazamento de ar. Registrou-se a pressão inicial (P1) no interior dos balonetes dos tubos traqueais utilizando-se manômetro digital graduado em centímetros de água, acoplado a seringa de 15 ml. Aspirou-se secreção da orofaringe. Com o meato acústico externo do examinador próximo da boca do paciente entre 10 e 20 cm, conectou-se o manômetro ao balonete, que foi esvaziado lentamente, até se ouvir ruído em sopro, pelo vazamento do volume corrente no período inspiratório da ventilação artificial. Neste momento, encheu-se lentamente o balonete até o desaparecimento do ruído. Anotou-se a pressão final (P2) do balonete e o volume de ar que restou na seringa do manômetro (V). RESULTADOS: As médias das pressões P1 nos grupos I e II foram 85,3 e 56,2 cmH2O, respectivamente. As médias de pressões P2 nos grupos I e II foram 26,7 e 15,5 cmH2O respectivamente. Após a manobra testada, o desvio padrão baixou de 56,3 para 8,2 no grupo I, e de 48 para 6,7 no grupo II. No grupo I, a manobra reduziu o volume e a pressão dos balonetes em 100% dos pacientes e no grupo II, em 97,3%. CONCLUSÕES: Os dois grupos apresentaram pressões no interior dos balonetes em níveis acima do necessário para ciclagem do ventilador sem perda do volume corrente. A manobra para manter a pressão no interior do balonete em níveis inferiores a 30 cmH2O foi simples e de pequeno custo.

Palavras-chave

EQUIPAMENTOS, INTUBAÇÃO TRAQUEAL, TÉCNICAS DE MEDIÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Since controlling tracheal tube cuffs internal pressure is unusual and there is no detailed description in the literature on how to maintain it below 30 cmH2O without manometer, this study aimed at checking tracheal tube intra-cuff pressures in intensive care unit and operating room patients. A maneuver was tested to keep intra-cuff pressure below 30 cmH2O, but at minimum levels needed for ventilator cycling with no tidal volume leakage. METHODS: Tracheal tube intra-cuff pressures were evaluated in 50 intensive care unit intubated patients (Group I) and 72 intubated patients in the operating room (Group II). A maneuver was tested to obtain the minimum tracheal tube intra-cuff pressure to maintain adequate ventilation with no air leakage. Initial tracheal tube intra-cuff pressure (P1) was recorded using a gaged digital manometer (cmH2O) coupled to a 15-ml syringe. Oropharynx secretion was aspirated. With the investigator’s external acoustic meatus positioned 10-20 cm apart from patient’s mouth and cuff connected to the manometer, cuff was slowly deflated until a murmur sound was heard, determined by tidal volume leakage during the inspiratory period of artificial ventilation. At this moment, cuff was slowly inflated until murmur disappearance. Final intra-cuff pressure (P2) and the remaining air volume in the manometer syringe (V) were recorded. RESULTS: Mean P1 values in groups I and II were 85.3 and 56.2 cmH2O, respectively. Mean P2 values in groups I and II were 26.7 and 15.5 cmH2O, respectively. After the maneuver, standard deviation decreased from 56.3 to 8.2 in group I, and from 48 to 6.7 in group II. Maneuver has decreased cuff volume and pressure in 100% of group I patients, and in 97.3% of group II patients. CONCLUSIONS: Both groups had intra-cuff pressures higher than necessary to keep ventilator cycling with no tidal volume leakage. Maneuver to keep intra-cuff pressure below 30 cmH2O was simple and cheap.

Keywords

EQUIPMENTS, MEASUREMENT TECHNIQUES, TRACHEAL INTUBATION

References

Grillo HC, Cooper JD, Geffin . A low-pressure cuff for tracheostomy tubes to minimize tracheal injury. J Thorac Cardiovasc Surg. 1971;62:898-907.

Mogovern GJ, Shively JG, Fecht D. The clinical and experimental evolution of a controlled-pressure intratracheal cuff. J Thorac Cardiovasc Surg. 1972;64:747-756.

Nordin U. The trachea and cuff-induced tracheal injury. Acta Otolaryngol. 1977;345:1-71.

Nordin U. The regeneration after cuff-induced tracheal injury. Acta Otolaryngol. 1982;94:541-555.

Ferdinende P, Kim D. Prevention of posintubation laryngotracheal stenosis. Acta Otorhinolarymgol Belg. 1995;49:341-346.

Grillo HC, Donahue DM, Mathisen DJ. Posintubation tracheal stenosis. J Thorac Cardiovasc Surg. 1995;109:486-493.

Forte V. Ressecção da estenose traqueal pós-intubação com reconstrução da traquéia por anastomose laringo, crico ou traqueotraqueal: análise clínica e cirúrgica. .

Goldberg M, Pearson FG. Pathogenesis of tracheal stenosis following tracheostomy with a cuff tube. Thorax. 1972;27:670-692.

Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheotomy. Am J Med. 1981;70:65-76.

Kastanos N, Miró RE, Perez AM. Laryngotracheal injury due to endotracheal intubation: Incidence, evolution, and predisposing factors. A prospective long-term study. Crit Care Med. 1983;11:362-367.

Pearson FG. Thoracic Surgery. 1995:251.

Lewis FR, Schlobohm RM, Thomas AN. Prevention of complications from prolonged tracheal intubation. Am J Med. 1978;135:452-457.

Oliveira C, Ferreira CAS, Feltrim MIZ. Avaliação da pressão do tubo endotraqueal nas primeiras horas do pós-operatório imediato de cirurgia cardíaca. Rev Bras Terap Intensiva. 1992;4:116-118.

Pippin LK, Bawes JB. Long-term tracheal intubation practice in the United Kingdom. Anaesthesia. 1983;38:791-795.

Messahel BF. Total tracheal obliteration after intubation with a low-pressure cuffed traqueal tube. Br J Anaesth. 1994;73:697-699.

Yang KL. Tracheal stenosis after a brief intubation. Anesth Analg. 1995;80:625-627.

Cooper JD, Grillo HC. The evolution of tracheal injury due to ventilatory assistance through cuffed tubes: a pathologic study. Ann Surg. 1969;169:334-348.

Bryce DP, Briant TDR, Pearson FG. Laryngeal and tracheal complications of intubations. Ann Otol. 1968;77:442-461.

Cooper JD, Grillo HC. Experimental production and prevention of injury due to cuffed tracheal tubes. Surg Gynecol Obstet. 1969;129:1235-1241.

Donnelly WH. Histopathology of endotracheal intubation. Arch Path. 1969;88:511-520.

Martins RHG, Braz JRC, Bretan . Lesões precoces da intubacão endotraqueal. Rev Bras Otorrinolaringol. 1995;61:1-4.

Stanley TH, Liu W. Tracheostomy and endotracheal tube cuff volume and pressure changes during thoracic operations. Ann Thorac Surg. 1975;20:145-151.

Passos E, Castilho VG. Papel da enfermagem na assistência ao paciente em ventilação mecânica. J Pneumol. 2000;26:27-34.

Tu HN, Saidi N, Lieutaud T. Nitrous oxide increases endotracheal cuff pressure and the incidence of tracheal lesions in anesthetized patients. Anesth Analg. 1999;89:187-190.

Braz JRC, Navarro LHC, Takata IH. Endotracheal tube cuff pressure: need for precise measurement. Med J Rev Paul Med. 1999;117:243-247.

Navarro LHC, Braz JRC, Pletsch AK. Estudo camparativo das pressões dos balonetes de tubos traqueais contendo ou não valvula reguladora de pressão de Lanz. Rev Bras Anestesiol. 2001;51:17-27.

Barbosa PMK, Santos BMO. Determinação do volume de ar no “cuff” de sondas endotraqueais. R Bras Enferm. 1996;49:225-238.

Bernhard WN, Yost L, Joynes D. Intracuff pressure in endotracheal and tracheostomy tubes. Chest. 1985;87:720-725.

Guyton DC, Barlow MR, Besselievre TR. Influence of airway pressure on minimum occlusive endotracheal tube cuff pressure. Crit Care Med. 1997;25:91-94.

Young PJ, Rollinson M, Downward G et al. Leakage of fluid past the tracheal tube cuff in a benchtop model. Br J Anaesth. 1997;78:557-562.

Young PJ, Ridley AS, Downward G. Evaluation of design tracheal tube cuff to prevent leakage of fluid to the lungs. Br J Anaesth. 1998;80:796-799.

Reali-Forster C, Kolobow T, Giacomini M. New ultrathin-walled endotracheal tube with a novel laryngeal seal design. Anesthesiology. 1996;84:162-172.

Young PJ, Blunt MC. Improving the shape and compliance characteristics of a high-volume, low-pressure cuff improves tracheal seal. Br J Anaesth. 1999;83:887-889.

Valles J, Artigas A, Rello J et al. Continuos aspiration of subglotic secretions in preventing ventilator associated pneumonia. Ann Intern Med. 1995;122:179-186.

5ddc3cd00e88250d16f2c91e rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections