Manômetros artesanais não medem com precisão a pressão de balão dos tubos endotraqueais / Handcrafted cuff manometers do not accurately measure endotracheal tube cuff pressure

RESUMOObjetivo:Testar a concordância entre dispositivos artesanais e um manômetro especificamente projetado para esse fim.Métodos:Testamos em 79 sujeitos a concordância entre as mensurações realizadas com 2 dispositivos artesanalmente adaptados para medir a pressão de balão dos tubos endotraqueais e as obtidas com uso de um manômetro específico para esse fim. A pressão de balão foi medida com um manômetro comercial e com dois dispositivos artesanais montados a partir de esfigmomanômetro aneroides. Os dados foram comparados utilizando os testes de Wilcoxon e Spearman, o coeficiente de correlação intraclasse e a análise do limite de concordância.Resultados:As pressões do balão medidas com os dispositivos artesanais foram significantemente diferentes das medidas obtidas com o dispositivo comercial (as pressões foram mais elevadas nas mensurações obtidas com o dispositivo artesanal 1 e mais baixas nas avaliações realizadas com o dispositivo artesanal 2). O coeficiente de correlação intraclasse entre o dispositivo comercial e os dispositivos 1 e 2 foi excelente (0,8; p < 0,001) e bom (0,66; p < 0,001), respectivamente. No entanto, os gráficos de Bland-Altman demonstraram limites amplos de concordância entre os dispositivos 1 e 2 e o dispositivo comercial.Conclusão:Os manômetros artesanais não proporcionam mensurações precisas da pressão do balão, quando comparados a um dispositivo específico para esse fim e, portanto, não devem ser utilizados na avaliação de pacientes mecanicamente ventilados em substituição aos manômetros comerciais específicos para avaliação da pressão do balão.

ABSTRACTObjective:To test the agreement between two handcrafted devices and a cuff-specific manometer.Methods:The agreement between two handcrafted devices adapted to measure tracheal tube cuff pressure and a cuff-specific manometer was tested on 79 subjects. The cuff pressure was measured with a commercial manometer and with two handcrafted devices (HD) assembled with aneroid sphygmomanometers (HD1 and HD2). The data were compared using Wilcoxon and Spearman tests, the intraclass correlation coefficient (ICC) and limit-of-agreement analysis.Results:Cuff pressures assessed with handcrafted devices were significantly different from commercial device measurements (pressures were higher when measured with HD1 and lower with HD2). The ICCs between the commercial device and HD1 and HD2 were excellent (ICC = 0.8 p < 0.001) and good (ICC = 0.66, p < 0.001), respectively. However, the Bland- Altman plots showed wide limits of agreement between HD1 and HD2 and the commercial device.Conclusion:The handcrafted manometers do not provide accurate cuff pressure measurements when compared to a cuff-specific device and should not be used to replace the commercial cuff manometers in mechanically ventilated patients.

Traqueostomía percutánea con asistencia fibrobroncoscópica: una década de experiencia en un hospital universitario / Fiber optic bronchoscopy-assisted percutaneous tracheostomy: a decade of experience at a university hospital

RESUMEN Objetivo: Evaluar eficacia y seguridad de la traqueostomía percutánea, mediante dilatación única con asistencia fibrobroncoscópica, en pacientes críticos sometidos a ventilación mecánica. Métodos: Entre los años 2004 y 2014, se incluyeron prospectivamente 512 enfermos consecutivos con indicación de traqueostomía según los criterios clínicos de nuestro centro. Un tercio de los pacientes fueron de alto riesgo. Se registraron variables demográficas, puntaje APACHE II, y días de ventilación mecánica previo a traqueostomía percutánea. La eficacia del procedimiento fue evaluada mediante tasa de éxito en su ejecución y necesidad de conversión a técnica abierta. La seguridad fue evaluada por tasa de complicaciones operatorias y postoperatorias. Resultados: La edad media del grupo fue 64 ± 18 años (203 mujeres y 309 varones). El puntaje APACHE II fue 21 ± 3. Los pacientes permanecieron en promedio 11 ± 3 días en ventilación mecánica antes de la realización de la traqueostomía percutánea. Todos los procedimientos se completaron exitosamente, sin necesidad de convertir a técnica abierta. Dieciocho pacientes (3,5%) presentaron complicaciones operatorias. Cinco pacientes experimentaron desaturación transitoria, cuatro presentaron hipotensión relacionada a la sedación, y nueve presentaron sangrado menor, pero ninguno requirió transfusión. No se registraron complicaciones graves, ni muertes asociadas al procedimiento. Once pacientes (2,1%) presentaron complicaciones postoperatorias. Siete presentaron sangrado menor y transitorio del estoma de la traqueostomía percutánea, 2 sufrieron desplazamiento de la cánula de traqueostomía y 2 desarrollaron infección superficial del estoma. Conclusión: La traqueostomía percutánea mediante la técnica de dilatación única con asistencia fibrobroncoscópica, parece ser efectiva y segura en enfermos críticos sometidos a ventilación mecánica, cuando es realizada por intensivistas experimentados mediante un abordaje ...

ABSTRACT Objective: To evaluate the efficacy and safety of percutaneous tracheostomy by means of single-step dilation with fiber optic bronchoscopy assistance in critical care patients under mechanical ventilation. Methods: Between the years 2004 and 2014, 512 patients with indication of tracheostomy according to clinical criteria, were prospectively and consecutively included in our study. One-third of them were high-risk patients. Demographic variables, APACHE II score, and days on mechanical ventilation prior to percutaneous tracheostomy were recorded. The efficacy of the procedure was evaluated according to an execution success rate and based on the necessity of switching to an open surgical technique. Safety was evaluated according to post-operative and operative complication rates. Results: The mean age of the group was 64 ± 18 years (203 women and 309 males). The mean APACHE II score was 21 ± 3. Patients remained an average of 11 ± 3 days on mechanical ventilation before percutaneous tracheostomy was performed. All procedures were successfully completed without the need to switch to an open surgical technique. Eighteen patients (3.5%) presented procedure complications. Five patients experienced transient desaturation, 4 presented low blood pressure related to sedation, and 9 presented minor bleeding, but none required a transfusion. No serious complications or deaths associated with the procedure were recorded. Eleven patients (2.1%) presented post-operative complications. Seven presented minor and transitory bleeding of the percutaneous tracheostomy stoma, 2 suffered displacement of the tracheostomy cannula, and 2 developed a superficial infection of the stoma. Conclusion: Percutaneous tracheostomy using the single-step dilation technique with fiber optic bronchoscopy assistance seems to be effective and safe in critically ill patients under mechanical ventilation when performed by experienced intensive care specialists using ...