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Klinische Evaluation eines Überdruckventils für Kindertuben mit Cuff

Clinical evaluation of a pressure release valve for paediatric cuffed tracheal tubes

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Zusammenfassung

Ziel

Zum sicheren Einsatz von Tuben mit Cuff bei Kindern ist eine Cuffdruckbegrenzung bei 20–25 cmH2O von entscheidender Bedeutung. Ziel der Studie war es, die Zuverlässigkeit und den Nutzen eines neuen Cuffüberdruckventils (Öffnungsdruck 20 cmH2O) in Kombination mit Tuben mit Cuff in der klinischen Anwendung bei Kindern zu evaluieren.

Methodik

In einer prospektiven Studie wurde der Cuffdruck bei Kindern und Adoleszenten, die mithilfe von Tuben mit Cuff intubiert waren und eine Sevofluran-Lachgas-Anästhesie erhielten, protokolliert. Das Cuffdruckentlastungsventil wurde zwischen Cuffmanometer und Pilotballon geschaltet. Bei 25 Patienten wurde die Messung vom initialen Öffnungsdruck (Gruppe A) aus und bei weiteren 25 Patienten vom minimalen Dichtungsdruck (Gruppe B) aus gestartet.

Ergebnisse

Fünfzig Patienten im Alter von 0,4 bis 17,8 Jahren (Median 7,4 Jahre) wurden in die Studie aufgenommen. Der Öffnungsdruck (Gruppe A) lag bei 19,7±0,8 cmH2O und der minimale Dichtungscuffdruck (Gruppe B) bei 11,7±2,9 cmH2O (Variationsbreite 6–16 cmH2O). Die mittleren Cuffdruckwerte in Gruppe A stabilisierten sich bei 20,4±1,6 cmH2O, während sich die Cuffdruckwerte in Gruppe B bei 16,5±3,3 cmH2O einpendelten. Bei einem Patienten der Gruppe A kam es zu einem Überschreiten der Cuffdruckgrenze von 25 cmH2O; dies hatte eine manuelle Entlastung gemäß Protokoll zur Folge. Insgesamt waren während 103,1 Messstunden 24 Nachfüllmanöver (14 in Gruppe A und 10 in Gruppe B) wegen Druckabfalls mit hörbarer Luftleckage notwendig. Die meisten davon waren durch Druckerhöhungen bei der Umlagerung des Patienten bzw. nachfolgender Entlastung durch das Überdruckventil verursacht.

Schlussfolgerung

Die vorliegende Untersuchung zeigt, dass das eingesetzte, einfache und leicht zu handhabende Cuffüberdruckventil zur intraoperativen Cuffdrucklimitierung bei Kindern und Adoleszenten mit geblockten Trachealtuben geeignet ist.

Abstract

Objective

The safe use of cuffed tracheal tubes for children necessitates a cuff pressure limitation at 20–25 cmH2O. The aim of the study was to evaluate the reliability and benefit of a new cuff pressure release valve (opening pressure 20 cmH2O) for children intubated with a cuffed tracheal tube.

Methods

In a prospective, observational trial cuff pressure was recorded in paediatric and adolescent patients intubated with a cuffed tracheal tube during sevoflurane/nitrous oxide anaesthesia. The cuff pressure release valve was interposed between the cuff manometer and the pilot balloon. In 25 patients measurements were started at the initial opening pressure (group A) and in a further 25 patients measurements were started at the minimal sealing cuff pressure (group B).

Results

A total of 50 patients, aged from 0.4 to 17.8 years (median 7.4 years) were enrolled in the study. The opening pressure measured (group A) was 19.7±0.8 cmH2O and the cuff sealing pressure (group B) was 11.7±2.9 cmH2O (range 6–16 cmH2O). Mean cuff pressure values in group A were 20.4±1.6 cmH2O and 16.5±3.3 cmH2O in group B. In one patient (group A) the cuff pressure exceeded 25 cmH2O and was manually decreased to 20 cmH2O. In total, 24 filling procedures (group A 14; group B 10) were required during 103.1 h of investigation because of cuff pressure drop and audible air leakage, mainly caused by cuff pressure increases and consequent releases during patient positioning.

Conclusion

Our data demonstrate that the tested cuff pressure release valve was useful and reliable to limit cuff pressure in tracheal intubated children and adolescents within an acceptable pressure range.

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Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkte in dem Artikel genannt sind, bestehen. Die getesteten Überdruckventile wurden vom lokalen Produktelieferanten kostenlos zur Verfügung gestellt. PD Dr. med. M. Weiss ist Berater der Fa. Covidien, Boulder, Colorado, die gecuffte Kindertuben herstellt und vertreibt.

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Authors and Affiliations

  1. Anästhesieabteilung, Universitäts-Kinderkliniken Zürich, Steinwiesstr. 75, Zürich, Schweiz

    S. Fertl, A. Schmitz, K. Woitzek &  M. Weiss

  2. Abteilung für Intensivmedizin und Neonatologie, Universitäts-Kinderkliniken Zürich, Zürich, Schweiz

    V. Bernet

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  1. S. Fertl
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  2. V. Bernet
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  3. A. Schmitz
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  4. K. Woitzek
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  5. M. Weiss
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Correspondence to M. Weiss.

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Fertl, S., Bernet, V., Schmitz, A. et al. Klinische Evaluation eines Überdruckventils für Kindertuben mit Cuff. Anaesthesist 58, 16–23 (2009). https://doi.org/10.1007/s00101-008-1473-0

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