응급의료센터 기관내 삽관 환자의 적절한 커프(cuff) 압력 유지를 위한 무저항 주사기(Loss of Resistance Syringe)의 적용

Abstract

Application of a Loss of Resistance Syringe for Obtaining the Adequate Cuff Pressures of Endotracheal Intubated Patients in an Emergency Department Hye Mi Kim, M.D., Jong Kab No, M.D., Young Soon Cho, M.D., Ho Jung Kim, M.D. Purpose: The endotracheal tube cuff pressure must be kept within the optimal range. This study compared the usefulness of the conventional pilot balloon palpation technique using a 10 cc disposable syringe and passive release technique using a Loss of Resistance (LOR) syringe for obtaining adequate intracuff pressures of endotracheal intubated patients in an emergency department. Methods: This was a prospective, observational study,conducted at the emergency department of a university teaching hospital. Patients who required endotracheal intubation in an emergency department were enrolled in this study. The patients were divided into two groups: one group who underwent the pilot balloon palpation technique using a conventional syringe (group A, n=40) and the other group who underwent the passive release technique using a LOR syringe technique (group B, n=40). The amount of air that infused into the cuff and the cuff pressure were measured. Results: The mean cuff pressures of groups A and B were 41.0±23.7 cmH2O and 23.7±16.5 cmH2O, respectively. The mean cuff pressure of group A were significantly higher than group B (p=0.002). The mean air volume that infused into the cuff of groups A and B were 8.6±2.6 ml and 7.6±2.4 ml, respectively, showing no significant difference (p=0.688). The proportion of the optimal cuff pressure (Normal range: 22-32 cmH2O) of group A (9/40, 22.5%)was higher than that of group B (3/40, 7.5%). Conclusion: The range of air volumes and pressures for cuff inflation varied and it may not be possible to obtain the appropriate pressure using the LOR syringe technique. The endotracheal tube cuff pressure must be kept within the optimal range using a pressure monitor control inflator.