Tube Exchanger를 사용한 기관내관 교체시 산소포화도 및 심박수에 미치는 영향

Abstract

There are several situations where the indications for changing an endotracheal tube is absolute and relative in ICU. Intubation times of 7 days or less have a low but significant incidence of serious sequelae in the modern ICU settings. In general, three techniques (Direct laryngoscopy, Tube exchangers, Fiberoptic bronchoscopy) are available for changing endotracheal tube. Each techniques is examined in terms of its advantages and disadvantages, along with its potential complication. The majority of anesthesiologists are familiar with direct laryngoscopy, however, the technique has some serious potential disadvantages. Direct laryngoscopy involves a significant stress on the cardiovascular system. Either this stress or the sedation that may be given to blunt it may be deleterious in a marginal patients. Use of tube exchangers have become popular because of their relative simplicity, widespread availability, and their potential for providing oxygenation, minimal need for sedatives and little hemodynamic insult, atraumatic teehniques. Ineluded in the study were 43 patients scheduled for changing of endotracheal tube admitted at ICU. The purpose of the present study is to compare with time, pulse rate, SaO2 between direct laryngoscopy and tube exchangers so as to endotracheal reintubation. The results were as follows. 1) Use of 19F sized tube exchanger, 21 cases were succeeded among 21 cases, but 3 cases were succeeded among 8 cases using 11F sized tube exchangers. 2) In the tube exchanger group, 28 cases among 29 cases were succeeded without use of sedatives or muscle relaxant. In laryngoscopy group, 10 cases among 14 cases were succeeded use of sedatives, 4 cases among 14 cases were succeeded use of muscle relaxants. 3) SaO2 was significantly lower in direct laryngoscopy group than tube exchanger group after tube exchange.