Strategies for Airway Management & Prevention Endotracheal Tube Cuff Intervention

气道管理策略

• 批准号: 7243618
• 负责人: Mary Lou Sole
• 金额: $ 21.72万
• 依托单位: UNIVERSITY OF CENTRAL FLORIDA
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-04-17 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7243618
• 关键词: Strategies; Airway; Management; Prevention; Endotracheal

DESCRIPTION (provided by applicant): The long-term goal of the proposed research is to reduce morbidity, mortality, and costs associated with ventilator-associated pneumonia (VAP). Critically ill patients who require mechanical ventilation are at high risk for VAP, a complication that results in (a) prolonged lengths of stay in the intensive care unit and hospital; (b) increased costs; (c) morbidity; and (d) mortality. Mechanical ventilation is provided via an artificial airway, the endotracheal tube (ETT). The ETT has a balloon or cuff at the distal end that is inflated to create a seal in the trachea. The ETT cuff pressure must be maintained within an optimal range that is high enough to ensure ventilation and prevent aspiration, yet low enough to ensure perfusion of the tracheal wall. While guidelines for optimal ETT cuff pressure have been established, maintaining pressure within an optimal range requires monitoring and attention to pressure variation. The current standard of care is intermittent measurement and adjustment of ETT cuff pressures every 8 to12 hours. This exploratory study proposes implementation of continuous monitoring of ETT cuff pressures to: 1) Identify clinical factors that influence ETT cuff pressures; 2) describe the natural history of ETT cuff pressures; and 3) test the effectiveness of an innovative airway management intervention-continuous monitoring of ETT cuff pressures with alarm triggers-versus the standard of care, on maintaining ETT cuff pressures within an optimal range. A randomized crossover design will be used. Subjects (n = 32) will be age 18 or older, have an oral ETT, and require mechanical ventilation. During the control period, ETT cuff pressures will be monitored continuously (but blinded to the investigators), and adjusted according to the standard of care. During the intervention, ETT cuff pressures will be continuously monitored, and pressures will be adjusted to optimal levels based on alarm triggers. Throughout both control and intervention periods, patient activities and nursing interventions will be recorded to assess effects on ETT cuff pressures. Data analysis will include repeated measures analysis, functional principal component analysis, and functional analysis of variance. Our hypotheses are that clinical factors will affect ETT cuff pressures, pressures will decrease over time, and that the novel intervention will be more effective than the standard of care in maintaining optimal cuff pressures. Improved management of the endotracheal tube may reduce the risk of ventilator associated pneumonia in critically ill patients and its associated morbidity and mortality. Findings will assist in designing airway management interventions and technologies to improve the outcomes of critically ill patients, and inform the development of an intervention/technology package to reduce VAP.

描述（由申请人提供）：拟议研究的长期目标是降低与呼吸机相关性肺炎（VAP）相关的发病率、死亡率和成本。需要机械通气的危重患者发生 VAP 的风险很高，这种并发症会导致 (a) 延长在重症监护室和医院的停留时间； (b) 成本增加； (c) 发病率； (d) 死亡率。机械通气通过人工气道、气管内插管 (ETT) 提供。 ETT 远端有一个气球或套囊，可充气以在气管中形成密封。 ETT 套囊压力必须保持在最佳范围内，该范围足够高以确保通气并防止误吸，但又足够低以确保气管壁的灌注。虽然已经制定了最佳 ETT 袖带压力指南，但将压力保持在最佳范围内需要监测并注意压力变化。目前的护理标准是每 8 至 12 小时间歇性测量和调整 ETT 袖带压力。这项探索性研究建议对 ETT 袖带压力进行连续监测，以： 1) 确定影响 ETT 袖带压力的临床因素； 2) 描述 ETT 袖带压力的自然历史； 3) 测试创新气道管理干预措施（通过警报触发持续监测 ETT 袖带压力）与护理标准的有效性，以将 ETT 袖带压力维持在最佳范围内。将使用随机交叉设计。受试者 (n = 32) 年龄为 18 岁或以上，接受口服 ETT，并需要机械通气。在控制期间，将持续监测 ETT 袖带压力（但对研究人员不知情），并根据护理标准进行调整。在干预期间，将持续监测 ETT 袖带压力，并根据警报触发将压力调整至最佳水平。在整个控制和干预期间，将记录患者活动和护理干预，以评估对 ETT 袖带压力的影响。数据分析将包括重复测量分析、功能主成分分析和功能方差分析。我们的假设是，临床因素会影响 ETT 袖带压力，压力会随着时间的推移而降低，并且新的干预措施在维持最佳袖带压力方面将比标准护理更有效。改进气管插管的管理可以降低危重患者发生呼吸机相关性肺炎的风险及其相关的发病率和死亡率。研究结果将有助于设计气道管理干预措施和技术，以改善危重患者的治疗结果，并为开发减少 VAP 的干预/技术包提供信息。