Automated Versus Manual Endotracheal Tube Cuff Pressure Control in Mechanically Ventilated Children: A Randomized Crossover Trial.

IF 1.6 4区医学 Q2 ANESTHESIOLOGY

Pediatric Anesthesia Pub Date : 2026-07-16 DOI:10.1002/pan.70268

Ekin Soydan, Esat Erdem Gokpınar, Ozlem Karakaya, Zeynep Gökoglu Sevinc, Gokhan Ceylan, Mehmet Gurkan Erbas, Selma Albayrak, Özlem Demirel, Ece Dorsan Yay, Kaan Aslan, Nihal Karaöz Özdamar, Nuriye Turgut, Utku Karaarslan, Hasan Agin

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引用次数: 0

Abstract

Background: Optimal endotracheal tube cuff pressure is key for airway sealing and minimizing microaspiration and tracheal injury in ventilated children. However, intermittent manual monitoring can allow significant pressure changes and be affected by measurement artifacts, potentially reducing airway protection.

Aims: This study evaluated whether automated cuff pressure control better maintains target pressure than manual monitoring in ventilated children, and assessed its effects on off-target pressure and workload.

Methods: In this prospective, randomized crossover study, mechanically ventilated pediatric patients (1 month-18 years) expected to require ventilation for ≥ 48 h underwent two randomized 24-h monitoring phases (manual and automated). During the manual phase, cuff pressure was continuously displayed via a closed system without repeated disconnection of the manometer and was intermittently adjusted by bedside nurses according to a predefined protocol. During the automated phase, cuff pressure was continuously regulated using an automated control system to maintain a target range of 15-25 cmH₂O. The primary outcomes were the frequency and cumulative duration of off-target cuff pressure exposure; secondary outcomes included nursing workload.

Results: Thirty-two patients completed both phases (768 measurements). Low cuff pressure episodes (< 15 cmH₂O) were more frequent during manual monitoring than automated monitoring (12.7% vs. 1.3%, p < 0.001), while high-pressure episodes (> 25 cmH₂O) occurred only during manual monitoring (2.6% vs. 0%, p < 0.001). Total time outside the target range was markedly reduced with automated monitoring (118 vs. 10 h, p < 0.001). Nursing workload was significantly lower in the automated phase (3.65 h vs. 0.08 h, p < 0.001).

Conclusions: Automated cuff pressure control more reliably maintains target pressure and minimizes clinically important deviations compared to manual management. These results support adopting continuous automated regulation as a preferred strategy to enhance airway safety and reduce workload in mechanically ventilated children.

Trial registration: ClinicalTrials.gov (NCT06965400).

查看原文本刊更多论文

机械通气儿童自动与手动气管插管袖口压力控制：一项随机交叉试验。

背景：优化气管内套管袖带压力是通气儿童气道密封和减少微误吸和气管损伤的关键。然而，间歇性的人工监测可能会导致明显的压力变化，并受到测量伪影的影响，潜在地降低气道保护。目的：本研究评估自动袖带压力控制是否比人工监测更能维持通气儿童的目标压力，并评估其对非目标压力和工作量的影响。方法：在这项前瞻性、随机交叉研究中，预计需要通气≥48小时的机械通气儿科患者（1个月-18岁）接受了两个随机的24小时监测阶段（手动和自动）。在手动阶段，袖带压力通过一个封闭系统连续显示，无需反复断开压力计，并由床边护士根据预定义的协议间歇性调整。在自动化阶段，使用自动化控制系统连续调节袖带压力，以保持15-25 cmH2O的目标范围。主要结局是脱靶袖带压力暴露的频率和累积时间；次要结局包括护理工作量。结果：32例患者完成了两个阶段（768次测量）。低袖带压发作（2O）在人工监测期间比自动监测期间更频繁（12.7%对1.3%,p 25 cmH2O）仅在人工监测期间发生（2.6%对0%，p）。结论：与人工管理相比，自动袖带压控制更可靠地维持目标压力，并最大限度地减少临床重要偏差。这些结果支持采用连续自动调节作为首选策略，以提高气道安全和减少机械通气儿童的工作量。试验注册：ClinicalTrials.gov （NCT06965400）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Anesthesia 医学-麻醉学

CiteScore

3.20

自引率

11.80%

发文量

222

审稿时长

3-8 weeks

期刊介绍： Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.