绘制气管内管阻塞的流行病学特征

CHEST critical care Pub Date : 2025-04-08 DOI:10.1016/j.chstcc.2025.100156

Vimal Bhardwaj MD, FNB(Critical Care), EDIC , Abhishek Samprathi MD, DrNB, EDIC , Manu M.K. Varma MD, DM , Kingshuk Saha MSc , Ross Prager MD , John Basmaji MD , Nicolas Orozco MD , Srirang Ramamoorthy MSc , Jose Chacko MD, EDIC , Arjun Alva MD

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引用次数: 0

摘要

背景：气管导管堵塞（ETBs）是ICU患者脱机失败、呼吸机不同步和缺氧的常见原因，但常被忽视，关于其患病率、临床因素和结局的研究有限。研究问题：ICU通气患者发生ETBs的发生率、危险因素及相关临床和呼吸机因素是什么？研究设计与方法对369例机械通气患者拔管后气管内插管进行评估。本前瞻性观察研究在印度班加罗尔Narayana卫生城的三级心胸重症监护室（CICUs）和内科重症监护室（MICUs）进行。目视检查管道，并在最大堵塞点切割管道，使用SketchAndCalc算法分析1200万像素相机捕获的横截面图像，以确定ETB百分比。结果在评估的369例ETBs中，ETBs被分为轻度（0%-9%）、中度（10%-49%）和重度(>；50%)闭塞。在CICU中，观察到严重的ETBs；而中度ETBs在CICU和MICU的患者中分别占27.9%和16.5%。单变量分析：吸力型(β = 9.62 [95% CI, 5.27 ~ 13.98]；P & lt;.01)，峰值压力(Ppeak；β = 1.73 [95% ci, 1.38-2.08]；P & lt;0.01)，凝血功能障碍(β = 9.42 [95% CI, 4.22-14.62]；P & lt;.01)， ICU类型(β = 9.62 [95% CI, 5.28 ~ 13.96]；P & lt;.01)有统计学意义。多变量回归分析仅显示Ppeak (β = 1.65 [95% CI, 1.28-2.02]；P & lt;.01)，凝血功能障碍(β = 8.02 [95% CI, 3.26-12.79]；P & lt;.01)且接受有创机械通气的天数较多(β = 0.02 [95% CI, 0.01-0.03]；P & lt;.01)是与ETB百分比相关的重要因素。中度ETB在ICU患者中更为普遍，其显著因素包括凝血功能障碍、闭合吸痰操作和机械通气时间。尽管有统计学意义，但峰值警报缺乏临床影响。临床试验注册中心-印度；否。: CTRI / 2023/10/058184;URL: www.ctri.nic.in

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Mapping the Epidemiologic Features of Endotracheal Tube Obstruction

Background

Endotracheal tube blockages (ETBs) are a common yet often overlooked cause of weaning failure, ventilator dyssynchrony, and hypoxia in the ICU, with limited studies on their prevalence, clinical factors, and outcomes.

Research Question

What are the incidence, risk factors, and associated clinical and ventilator factors of ETBs in ventilated patients in the ICU?

Study Design and Methods

We assessed 369 endotracheal tubes (ETTs) of mechanically ventilated patients after extubation. This prospective observational study was conducted at the tertiary cardiothoracic ICUs (CICUs) and medical ICUs (MICUs) of Narayana Health City, Bengaluru, India. Tubes were inspected visually and were cut at the point of maximum blockage, and cross-sectional images captured with a 12-megapixel camera were analyzed for ETB percentage using the SketchAndCalc algorithm.

Results

Of the 369 ETTs assessed, ETBs were categorized as showing low (0%-9%), moderate (10%-49%), and severe (> 50%) occlusion. In the CICU, severe ETBs was observed in < 2% of patients, compared with 4% of patients in the MICU, whereas moderate ETBs were present in 27.9% of patients in the CICU and 16.5% of patients in the MICU. On univariable analysis, suction type (β = 9.62 [95% CI, 5.27-13.98]; P < .01), peak pressure (P_peak; β = 1.73 [95% CI, 1.38-2.08]; P < .01), coagulopathy (β = 9.42 [95% CI, 4.22-14.62]; P < .01), and ICU type (β = 9.62 [95% CI, 5.28-13.96]; P < .01) were statistically significant. Multivariable regression analysis showed only P_peak (β = 1.65 [95% CI, 1.28-2.02]; P < .01), coagulopathy (β = 8.02 [95% CI, 3.26-12.79]; P < .01) and larger number of days receiving invasive mechanical ventilation (β = 0.02 [95% CI, 0.01-0.03]; P < .01) to be significant factors associated with ETB percentage.

Interpretation

Moderate ETB was more prevalent in patients in the ICU, with significant factors including coagulopathy, closed suction practice, and mechanical ventilation duration. P_peak alarms lacked clinical impact, despite statistical significance.

Clinical Trial Registry

Clinical Trial Registry-India; No.: CTRI/2023/10/058184; URL: www.ctri.nic.in

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CHEST critical care Critical Care and Intensive Care Medicine, Pulmonary and Respiratory Medicine

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