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頭頸部伸展後のテーパー型および円筒型カフの圧力変化：ランダム化比較試験
Pressure changes in tapered and cylindrical shaped cuff after extension of head and neck: A randomized controlled trial.
PMID: 36387810
抄録
背景:
気管内チューブ（ET）の適切なカフ圧は、人工呼吸中の気道封鎖と気道合併症の予防に重要な役割を果たす。ETのカフ形状は、体位変換後のカフ圧に影響を与える。
BACKGROUND: The proper cuff pressure of endotracheal tube (ET) plays an important role in sealing the airway and preventing airway complications during mechanical ventilation. The ET cuff shape affects the cuff pressure after positional change.
目的:
経鼻気管内挿管時に頭頸部を伸展させたときのカフ圧をテーパー型と円筒型とで検討する。
AIM: To investigate cuff pressure between tapered and cylindrical cuff after extension of head and neck during nasal endotracheal intubation.
方法:
無作為化臨床試験において、52名の患者を円筒型カフとTapered cuffの2群に無作為に割り付けた。カフ圧は22cmHOで、患者をニュートラルポジションにした状態で適用した。頭部と頸部を伸展させた後、カフ圧を再度評価し、22 cmHOに再調整した。また、ET先端の頭側への移動の程度を評価し、術後の気道合併症（咽頭痛、嗄声など）を測定した。
METHODS: In a randomized clinical trial, 52 patients were randomized to one of two groups: cylindrical cuff or Tapered cuff. Cuff pressure with 22 cmHO was applied to patients in the neutral position. After extension of head and neck, the cuff pressure was evaluated again and readjusted to 22 cmHO. In addition, the extent of cephalad migration of ET tip was assessed and postoperative airway complications such as sore throat, and hoarseness were measured.
結果:
頭頸部伸展後のカフ圧は、テーパーカフ（28.7 ± 1.0 cmHO）が円筒カフ（25.5 ± 0.8 cmHO）より高かった（＜0.001）。チューブ先端の頭側への移動の程度は、テーパーガードET（18.4±2.2mm）が従来のET（15.1±1.2mm）より大きかった（ 0.001）．術後の気道合併症の発生率は2群間で同等であった。
RESULTS: The cuff pressure was higher in the tapered cuff (28.7 ± 1.0 cmHO) than in the cylindrical cuff (25.5 ± 0.8 cmHO) after head and neck extension ( < 0.001). The extent of cephalad migration of tube tip was greater in TaperGuard ET (18.4 ± 2.2 mm) than in conventional ET (15.1 ± 1.2 mm) ( 0.001). The incidence of postoperative airway complications was comparable between two groups.
結論:
頭頸部伸展後、鼻腔挿管時のカフ圧とETの頭側移動の程度は、それぞれ円筒カフよりテーパーカフの方が大きかった。
CONCLUSION: After head and neck extension, the cuff pressure and the extent of cephalad migration of ET was greater in tapered cuff than in cylindrical cuff during nasal intubation, respectively.