TRACHEAL TUBE LEAK TEST - IS THERE INTEROBSERVER AGREEMENT
TRACHEAL TUBE LEAK TEST - IS THERE INTEROBSERVER AGREEMENT
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DOI：
10.1007/bf03009476
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发表时间：
1993-11-01
期刊：
影响因子：
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通讯作者：
PASQUARIELLO, CA
中科院分区：
文献类型：
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作者：
SCHWARTZ, RE;STAYER, SA;PASQUARIELLO, CA
尽管泄漏试验被推荐作为评估儿童使用的无套囊气管插管的适当尺寸的方法，但该试验的重现性尚未得到验证。研究了从新生儿到10岁需要气管插管进行择期手术的患者。使用公式计算气管插管尺寸。(age+16）除以4，对于大于或等于两岁的患者，对于小于两岁的患者，由主治麻醉师酌情决定。在麻醉诱导和非去极化肌松剂给药后，对患者气管插管，并确认气管中段置入。参与研究的三名麻醉师中的两名连续评估泄漏压力。每名参与者进行一次泄漏测定。羽衣甘蓝压力测定如下：患者仰卧，头部处于中立位置，新鲜气体以5 L流入呼吸回路。min-1时，将听诊器放置在喉部上方的皮肤上，并将减压阀完全关闭。 呼吸回路中的压力缓慢增加，直到气管插管周围出现可听到的泄漏。计算了212例患者的观察者间差异。 随着平均泄漏压力的增加，两个观察者之间的差异的绝对值也增加。然而，观察员之间的变化表示为绝对测量值的百分比保持不变。在低和高Kak压力下，测量的平均方差为38%。总之，我们发现两个有经验的观察者在评估泄漏压力时存在相当大的差异。随着泄漏压力的增加，这些观察结果之间的差异也会增加。 因此，我们认为对更换所有气管插管设定泄漏压力上限是不合理的。
Although the leak test is recommended as a method of assessing the appropriate size of uncuffed endotracheal tubes for use in children, the reproducibility of this test has not been validated. Patients from newborn to ten years of age requiring tracheal intubation for elective surgery were studied. The endotracheal tube size was calculated using the formula. (age + 16) divided-by 4 for patients greater-than-or-equal-to two years of age and at the discretion of the attending anaesthetist for patients < two years of age. After the induction of anaesthesia and administration of a non-depolarizing muscle relaxant, the patient's trachea was intubated and mid-tracheal placement was confirmed. Two of the three staff anaesthetists participating in the study assessed the leak pressure consecutively. Each participant performed a single leak determination The kale pressure was determined as follows: the patient was supine with the head in a neutral position, fresh gas flowed into the breathing circuit at 5 L . min-1, a stethoscope was placed on the skin over the larynx and the pressure relief valve was completely closed. Pressure slowly increased in the breathing circuit until an audible leak occurred around the tracheal tube. The inter-observer difference was calculated in 212 patients. The absolute value of the difference between that of two observers increased as the mean leak pressure increased. However, the variation between observers expressed as a percent of the absolute measurement remained constant. An average variance in measurement of 38% was found al both low and high kak pressures. In conclusion, we found considerable variation between two experienced observers in assessing leak pressures As the leak pressures increase, the difference between these observations also increases. Therefore, we believe it is unreasonable to set an upper limit of leak pressure for changing all endotracheal tubes.