Tubo endotraqueal atraumático para ventilação mecânica

Silvio Oscar Noguera Servin; Gilson Barreto; Luiz Cláudio Martins; Marcos Mello Moreira; Luciana Meirelles; José Alexandre Colli Neto; José Hélio Zen Júnior; Alfio José Tincani

doi:10.1590/S0034-70942011000300006

Scientific Article

Tubo endotraqueal atraumático para ventilação mecânica

Atraumatic endotracheal tube for mechanical ventilation

Silvio Oscar Noguera Servin; Gilson Barreto; Luiz Cláudio Martins; Marcos Mello Moreira; Luciana Meirelles; José Alexandre Colli Neto; José Hélio Zen Júnior; Alfio José Tincani

http://dx.doi.org/10.1590/S0034-70942011000300006 Braz J Anesthesiol, vol.61, n3, p.315-319, 2011

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JUSTIFICATIVA E OBJETIVOS: Pacientes que necessitam permanecer sob intubação endotraqueal (IOT) por longos períodos ou, se submetidos à anestesia geral, poderão ter lesões na luz da traqueia devido a pressões exercidas pelo balonete terminal. Em alguns casos, essas lesões poderão evoluir para estenose ou, ocasionalmente, necrose. O presente trabalho teve por objetivo apresentar um tubo endotraqueal modificado (TETM) em que a pressão do balonete é variável de acordo com o ciclo da ventilação mecânica (VM), sendo o mesmo testado em simulador pulmonar e modelo animal. MÉTODO: Em simulador pulmonar acoplado a ventilador mecânico ajustado com dois volumes correntes (VC) de 10 e 15 mL.kg-1 e complacência de 60 mL.cmH2O-1, foram utilizados dois modelos de tubos endotraqueais: um modificado (TETM) e outro convencional (TETC), números (#) 7,5 mm e 8,0 mm, para avaliar a eficiência da ventilação com o TETM. Realizou-se também a comparação entre os dois modelos, em porcos da raça Large-White, sob anestesia geral e VM por 48 horas consecutivas. Posteriormente, os animais foram sacrificados para análise histopatológica das traqueias. RESULTADOS: Ambos os TETMs (#7,5 e 8,0) apresentaram escape de ar no simulador pulmonar. O menor escape de ar (13%) foi observado no TETM #7,5 mm com VC = 15 mL.kg-1 e o maior (32%) no TETM #8,0 mm, com VC = 10 mL.kg-1. Apesar disso, ambos os TETMs apresentaram boa eficiência no simulador pulmonar. Na avaliação do uso dos TETs em animais com análise histopatológica de suas traqueias, verificou-se que o TETM causou menos áreas traumáticas em seu epitélio em comparação ao TETC. CONCLUSÕES: O uso de um novo modelo de TET poderá diminuir os riscos de lesão traqueal sem prejuízo à mecânica respiratória.

Palavras-chave

ANIMAL, AVALIAÇÃO, COMPLICAÇÕES, EQUIPAMENTOS, REANIMAÇÃO

Abstract

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.cmH2O 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.

Keywords

Intubation, Intratracheal, Disposable equipament, Technology Assessment, Biomedical, Respiration, Artificial, Swine

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Tubo endotraqueal atraumático para ventilação mecânica

Atraumatic endotracheal tube for mechanical ventilation

Silvio Oscar Noguera Servin; Gilson Barreto; Luiz Cláudio Martins; Marcos Mello Moreira; Luciana Meirelles; José Alexandre Colli Neto; José Hélio Zen Júnior; Alfio José Tincani

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