PDF(Pubmed)
Abstract：
Incomplete sealing of tracheal diverticula by a tracheal tube cuff during positive-pressure ventilation causes barotrauma but the concrete possibility of incomplete sealing has not been indicated. We aimed to assess the possibility of incomplete sealing in a simulated situation of tracheal intubation for patients with tracheal diverticula with tube fixation where the tracheal tube\'s vocal cord guide overlaps with the patient\'s vocal cord.
We retrospectively assessed the characteristics of tracheal diverticula based on thoracic computed tomography data in our institution from January 2018 to July 2020. Then, we assessed the structural parameters of three single-lumen tracheal tubes (Parker Flex-Tip [Parker Medical, Bridgewater, CT, USA], Portex Soft Seal [ICU Medical, San Clemente, CA, USA], and Shiley TaperGuard [Medtronic, Dublin, Ireland]; 6.0-8.0 mm inner diameter size) and simulated the positional relationships between tracheal diverticula and the tracheal tube during tracheal intubation where the vocal cord guide overlaps with the patient\'s vocal cord. We assessed each tube product\'s possibility of incompletely sealing tracheal diverticula and the possibility of unintended bronchial intubation.
In 5,854 patients, the prevalence of tracheal diverticula was 5.7%. The mean (SD) length from the vocal cord to the distal end of the tracheal diverticula was 52.2 (12.8) mm. Tracheal tubes with length from the distal end of the tracheal cuff to the vocal cord guide of ≥ 70 mm had a low risk of incompletely sealing tracheal diverticula (< 5%) and length from the distal end of the tube to the vocal cord guide of ≤ 95 mm had a low risk of unintended bronchial intubation (< 5%). No products in this study satisfied both outcomes.
Tube fixation, where the vocal cord guide overlaps with the patient\'s vocal cord, is associated with risk of incompletely sealing of tracheal diverticula depending on the tube\'s manufacturer and tube\'s inner diameter size, although it was not a high risk. The use of small inner diameter sized tube relative to patient\'s body size is high risk of incomplete sealing of tracheal diverticula.
This trial was prospectively registered at University Hospital Medical Information Network (UMIN).
UMIN000043317 (URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048055 ).
We retrospectively assessed the characteristics of tracheal diverticula based on thoracic computed tomography data in our institution from January 2018 to July 2020. Then, we assessed the structural parameters of three single-lumen tracheal tubes (Parker Flex-Tip [Parker Medical, Bridgewater, CT, USA], Portex Soft Seal [ICU Medical, San Clemente, CA, USA], and Shiley TaperGuard [Medtronic, Dublin, Ireland]; 6.0-8.0 mm inner diameter size) and simulated the positional relationships between tracheal diverticula and the tracheal tube during tracheal intubation where the vocal cord guide overlaps with the patient\'s vocal cord. We assessed each tube product\'s possibility of incompletely sealing tracheal diverticula and the possibility of unintended bronchial intubation.
In 5,854 patients, the prevalence of tracheal diverticula was 5.7%. The mean (SD) length from the vocal cord to the distal end of the tracheal diverticula was 52.2 (12.8) mm. Tracheal tubes with length from the distal end of the tracheal cuff to the vocal cord guide of ≥ 70 mm had a low risk of incompletely sealing tracheal diverticula (< 5%) and length from the distal end of the tube to the vocal cord guide of ≤ 95 mm had a low risk of unintended bronchial intubation (< 5%). No products in this study satisfied both outcomes.
Tube fixation, where the vocal cord guide overlaps with the patient\'s vocal cord, is associated with risk of incompletely sealing of tracheal diverticula depending on the tube\'s manufacturer and tube\'s inner diameter size, although it was not a high risk. The use of small inner diameter sized tube relative to patient\'s body size is high risk of incomplete sealing of tracheal diverticula.
This trial was prospectively registered at University Hospital Medical Information Network (UMIN).
UMIN000043317 (URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048055 ).
摘要：
背景：在正压通气过程中，气管套管套囊对气管憩室的不完全密封会引起气压伤，但尚未表明不完全密封的具体可能性。我们的目的是评估在气管导管的声带与患者的声带重叠的情况下，气管憩室患者气管插管的模拟情况下不完全密封的可能性。
方法：我们根据2018年1月至2020年7月在我们机构的胸部计算机断层扫描数据回顾性评估了气管憩室的特征。然后，我们评估了三种单腔气管导管的结构参数(ParkerFlex-Tip[ParkerMedical，布里奇沃特,CT,美国],Portex软密封[ICUMedical,圣克莱门特,CA,美国],和ShileyTaperGuard[美敦力，都柏林,Ireland];6.0-8.0mm内径大小），并模拟了气管插管过程中气管憩室与气管导管之间的位置关系，其中声带导管与患者的声带重叠。我们评估了每种管产品不完全密封气管憩室的可能性和意外支气管插管的可能性。
结果：在5,854名患者中，气管憩室的患病率为5.7%。从声带到气管憩室远端的平均长度（SD）为52.2（12.8）mm。从气管套远端到声带导管的长度≥70mm的气管导管具有不完全密封气管憩室的低风险（<5％），从导管远端到声带导管的长度≤95mm具有意外支气管插管的低风险（<5％）。本研究中没有产品满足这两个结果。
结论：管固定，其中声带导管与患者的声带重叠，与气管憩室不完全密封的风险相关，具体取决于管的制造商和管的内径大小，虽然风险不高.使用相对于患者身体尺寸的小内径大小的管是气管憩室不完全密封的高风险。
背景：该试验在大学医院医学信息网络（UMIN）进行了前瞻性注册。
背景：UMIN000043317（URL：https://center6。乌明。AC.jp/cgi-open-bin/ctr_e/ctr_view。cgi?recptno=R000048055)。
方法：我们根据2018年1月至2020年7月在我们机构的胸部计算机断层扫描数据回顾性评估了气管憩室的特征。然后，我们评估了三种单腔气管导管的结构参数(ParkerFlex-Tip[ParkerMedical，布里奇沃特,CT,美国],Portex软密封[ICUMedical,圣克莱门特,CA,美国],和ShileyTaperGuard[美敦力，都柏林,Ireland];6.0-8.0mm内径大小），并模拟了气管插管过程中气管憩室与气管导管之间的位置关系，其中声带导管与患者的声带重叠。我们评估了每种管产品不完全密封气管憩室的可能性和意外支气管插管的可能性。
结果：在5,854名患者中，气管憩室的患病率为5.7%。从声带到气管憩室远端的平均长度（SD）为52.2（12.8）mm。从气管套远端到声带导管的长度≥70mm的气管导管具有不完全密封气管憩室的低风险（<5％），从导管远端到声带导管的长度≤95mm具有意外支气管插管的低风险（<5％）。本研究中没有产品满足这两个结果。
结论：管固定，其中声带导管与患者的声带重叠，与气管憩室不完全密封的风险相关，具体取决于管的制造商和管的内径大小，虽然风险不高.使用相对于患者身体尺寸的小内径大小的管是气管憩室不完全密封的高风险。
背景：该试验在大学医院医学信息网络（UMIN）进行了前瞻性注册。
背景：UMIN000043317（URL：https://center6。乌明。AC.jp/cgi-open-bin/ctr_e/ctr_view。cgi?recptno=R000048055)。
