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引用次数: 0
摘要
随着我们知识的增长,气道解剖和管理的原则不断受到重新评估和挑战。这使我们对小儿气道及其与成人气道的重要区别有了更深入的了解。对小儿气道大小和形状不断发展的认识对手术室、急诊科和重症监护室的气道管理具有重要的临床意义。临床实践中的第一个重大变化是向常规使用带袖带的气管导管 (ETT) 过渡。聚氨酯充气罩囊 Microcuff® 的出现以及重新设计的充气罩囊在 ETT 轴上的位置(没有墨菲眼)为这一转变提供了便利。可能有必要对 ETT 上充气罩囊的设计和位置以及 ETT 轴上的插管深度标记给予更多关注,以确保在气管插管后将充气罩囊完全置于环甲膜环下方。充气罩囊在环状环内压力过高时可能会影响气管粘膜的灌注并导致气道损伤。
Evolution of the concepts of pediatric airway and endotracheal intubation
The tenets of airway anatomy and management continue to be reevaluated and challenged as our knowledge increases. This has led to a better understanding of the pediatric airway and its critical differences from adults. This evolving understanding of the pediatric airway size and shape has significant clinical implications to airway management in the operating room, emergency department, and the intensive care unit. The first significant change in clinical practice was the transition to the routine use of cuffed endotracheal tubes (ETTs). This was facilitated by the availability of the Microcuff® with a polyurethane cuff and a redesigned position of the cuff on the shaft of the ETT without the Murphy's eye. Additional attention to the design and the location of the cuff on the ETT may be necessary as well as to markings for depth of intubation on the shaft of the ETT to ensure that the cuff is placed fully below the cricoid ring following endotracheal intubation. Inflation of the cuff with high intracuff pressures within the cricoid ring may compromise perfusion of the tracheal mucosa and result in airway injury.