Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942011000300006
Brazilian Journal of Anesthesiology
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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Resumo

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

References

Sole ML, Penoyer DA, Su X. Assessment of endotracheal cuff pressure by continuous monitoring: a pilot study. Am J Crit Care. 2009;18:133-143.

Bain JA. Late complications of tracheostomy and prolonged endotracheal intubation. Int Anesthesiol Clin. 1972;10:225-244.

Tornvall SS, Jackson KH, Oyanedel E. Tracheal rupture, complication of cuffed endotracheal tube. Chest. 1971;59:237-239.

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

Bishop MJ. Mechanisms of laryngotracheal injury following prolonged tracheal intubation. Chest. 1989;96:185-186.

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

McCulloch TM, Bishop MJ. Complications of translaryngeal intubation. Clin Chest Med. 1991;12:507-521.

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

Kamen JM, Wilkinson CJ. A new low-pressure cuff for endotracheal tubes. Anesthesiology. 1971;34:482-485.

Arola MK, Anttinen J. Post-mortem findings of tracheal injury after cuffed intubation and tracheostomy: A clinical and histopathological study. Acta Anaesthesiol Scand. 1979;23:57-68.

Conti M, Pougeoise M, Wurtz A. Management of postintubation tracheobronchial ruptures. Chest. 2006;130:412-418.

Lindholm CE. Experience with a new orotracheal tube. Acta Otolaryngol (Stockh). 1973;75:389-390.

Nordin U, Lindholm CE, Wolgast M. Blood flow in the rabbit tracheal mucosa under normal conditions and under the influence of tracheal intubation. Acta Anaesthesiol Scand. 1977;21:81-94.

Moro ET. Prevenção da aspiração pulmonar do conteúdo gástrico. Rev Bras Anestesiol. 2004;54:261-275.

AARC (American Association for Respiratory Care) clinical practice guideline: Management of airway emergencies. Respir Care. 1995;40:749-760.

Brichet A, Verkindre C, Dupont J. Multidisciplinary approach to management of postintubation tracheal stenoses. Eur Respir J. 1999;13:888-893.

Lindholm CE. Prolonged endotracheal intubation. Acta Anaesthesiol Scand. 1970:1-131.

Klainer AS, Turndorf H, Wu WH. Surface alterations due to endotracheal intubation. Am J Med. 1975;58:674-683.

Paegle RD, Ayres SM, Davis S. Rapid tracheal injury by cuffed airways and healing with loss of ciliated epithelium. Arch Surg. 1973;106:31-34.

Bryant LR, Trinkle JK, Dubilier L. Reappraisal of tracheal injury from cuffed tracheostomy tubes: Experiments in dogs. JAMA. 1971;215:625-628.

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

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