The influence of endotracheal tube leak on the assessment of respiratory function in ventilated children

被引:74
作者
Main, E
Castle, R
Stocks, J
James, I
Hatch, D
机构
[1] Inst Child Hlth, Portex Anaesthesia Intens Therapy & Resp Med Unit, London WC1N 1EH, England
[2] Great Ormond St Hosp Children NHS Trust, Physiotherapy Dept, London WC1 3JH, England
[3] Great Ormond St Hosp Children NHS Trust, Cardioresp & Crit Care Unit, London WC1 3JH, England
关键词
ventilators; mechanical; respiration; artificial; intubation; intratracheal; respiratory function tests; respiratory mechanics; child;
D O I
10.1007/s001340101105
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: The use of respiratory mechanics to optimise ventilator settings has become more common since the integration of pressure and flow transducers into modern ventilators. However, values of respiratory resistance (R-rs) and compliance (C-rs) can be overestimated in the presence of tracheal tube leak and clinical decisions based on these figures would be misinformed. This study aimed to assess the influence of tracheal tube leak on measurements of Cr,, Rr and expired tidal volume (V-TE) in ventilated children in order to establish when such measurements were reliable in this population. Design: Respiratory function was monitored for at least five consecutive hours during which normal medical procedures were performed. The magnitude and variability of tracheal tube leak was assessed during these periods. Setting: The paediatric and cardiac intensive care units at Great Ormond Street Hospital for Children, NHS Trust, London. Patients: Seventy-five paralysed, fully ventilated infants and children. Results: Ten children had a mean leak greater than 20 % (range: 22 % -65 %). Amongst this group there were wide fluctuations with respect to leak magnitude, V-TE, C-rs and R-rs Leaks of less than 20 % appeared necessary to obtain reliable measurements of C-rs and R-rs and to ensure consistent and adequate ventilation. Conclusions: Leaks larger than 20% result in inconsistent tidal volume delivery and gross overestimation of C-rs and R-rs irrespective of ventilation mode. The magnitude of tracheal tube leak needs to be accurately displayed on all ventilatory equipment to verify reliable measures of respiratory function so that appropriate clinical decisions can be made and ventilatory management optimised.
引用
收藏
页码:1788 / 1797
页数:10
相关论文
共 37 条
[1]   INCIDENCE OF ASPIRATION WITH ENDOTRACHEAL-TUBES IN CHILDREN [J].
BROWNING, DH ;
GRAVES, SA .
JOURNAL OF PEDIATRICS, 1983, 102 (04) :582-584
[2]   Tidal volumes for ventilated infants should be determined with a pneumotachometer placed at the endotracheal tube [J].
Cannon, ML ;
Cornell, J ;
Tripp-Hamel, DS ;
Gentile, MA ;
Hubble, CL ;
Meliones, JN ;
Cheifetz, IM .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2000, 162 (06) :2109-2112
[3]   CHANGES IN PULMONARY MECHANICS AFTER THE ADMINISTRATION OF SURFACTANT TO INFANTS WITH RESPIRATORY-DISTRESS SYNDROME [J].
DAVIS, JM ;
VENESSMEEHAN, K ;
NOTTER, RH ;
BHUTANI, VK ;
KENDIG, JW ;
SHAPIRO, DL .
NEW ENGLAND JOURNAL OF MEDICINE, 1988, 319 (08) :476-479
[4]   CUFFED ENDOTRACHEAL-TUBES IN PEDIATRIC INTENSIVE-CARE [J].
DEAKERS, TW ;
REYNOLDS, G ;
STRETTON, M ;
NEWTH, CJL .
JOURNAL OF PEDIATRICS, 1994, 125 (01) :57-62
[5]   IMMEDIATE EFFECTS ON LUNG-FUNCTION OF INSTILLED HUMAN SURFACTANT IN MECHANICALLY VENTILATED NEWBORN-INFANTS WITH IRDS [J].
EDBERG, KE ;
EKSTROMJODAL, B ;
HALLMAN, M ;
HJALMARSON, O ;
SANDBERG, K ;
SILBERBERG, A .
ACTA PAEDIATRICA SCANDINAVICA, 1990, 79 (8-9) :750-755
[6]   EFFECTS OF ENDOTRACHEAL-TUBE LEAKS ON FUNCTIONAL RESIDUAL CAPACITY DETERMINATION IN INTUBATED NEONATES [J].
FOX, WW ;
SCHWARTZ, JG ;
SHAFFER, TH .
PEDIATRIC RESEARCH, 1979, 13 (01) :60-64
[7]   Specifications for equipment used for infant pulmonary function testing [J].
Frey, U ;
Stocks, J ;
Coates, A ;
Sly, P ;
Bates, J .
EUROPEAN RESPIRATORY JOURNAL, 2000, 16 (04) :731-740
[8]   Specifications for signal processing and data handling used for infant pulmonary function testing [J].
Frey, U ;
Stocks, J ;
Sly, P ;
Bates, J .
EUROPEAN RESPIRATORY JOURNAL, 2000, 16 (05) :1016-1022
[9]   IMMEDIATE IMPROVEMENT IN LUNG-VOLUME AFTER EXOGENOUS SURFACTANT - ALVEOLAR RECRUITMENT VERSUS INCREASED DISTENSION [J].
GOLDSMITH, LS ;
GREENSPAN, JS ;
RUBENSTEIN, SD ;
WOLFSON, MR ;
SHAFFER, TH .
JOURNAL OF PEDIATRICS, 1991, 119 (03) :424-428
[10]   INFANT LUNG-FUNCTION TESTING IN THE INTENSIVE-CARE UNIT [J].
HAMMER, J ;
NEWTH, CJL .
INTENSIVE CARE MEDICINE, 1995, 21 (09) :744-752