| BackgroundCuff pressure is affected by many factors.How to effectively maintain the cuff pressure within the normal range(25～30 cmH2O)to reduce the occurrence of ventilators associated pneumonia,aspiration and other complications is important.However,the optimal inflating volume of the modified cuff pressure measurement method and the change law of cuff pressure before and after common nursing procedures have not been clarified.Objective1.To explore the effect of different inflating volume on the cuff pressure by the modified cuff pressure measurement method and clarify the optimal inflating volume.2.To explore the change law of cuff pressure before and after nursing procedures of sputum suction,oral care,atomization inhalation and turning over.3.To calculate the critical value of cough strength during sputum suction for substandard cuff pressure.Methods1.Combining in vitro and clinical studies,the traditional cuff pressure measurement method and the modified cuff pressure measurement method were used to measure cylindrical and tapered cuffs,and the effect of different inflating volume on cuff pressure was analyzed statistically.2.A observational study design was used to select 56 patients with artificial airway from June to December 2020.Cuff pressure changes before and after four nursing procedures of sputum suction,oral care,atomization inhalation and turning over were continuously monitored.The semi-quantitative cough strength score(SCSS)was used to assess the cough strength during sputum suction.Statistics and analysis of the cuff pressure values at different time points were performed.3.A observational study design was used to select 50 patients with artificial airway from June 2020 to February 2021.The correlation between cough strength during sputum suction and substandard cuff pressure was statistically analyzed,and the critical value of cough strength for substandard cuff pressure was calculated by drawing the receiver operating characteristic(ROC)curve.Results1.In vitro and clinical studies showed that the overall range of the pressure loss value of the traditional cuff pressure measurement method was 3.75±0.31～5.17±0.93 cmH2O,while the overall difference range between the actual measured value of the modified cuff pressure measurement method and the corrected target value was 0.00～1.23±0.25 cmH2O.In vitro study showed that the pressure coefficient of variation of the tapered cuff was higher than that of the cylindrical cuff(3.08±0.25 vs.2.41±0.21,P<0.001).2.The cuff pressure(maximum value)during the four nursing procedures of sputum suction,oral care,atomization inhalation and turning over was higher than that before implementing the procedure(P<0.001),and the cuff pressure at 20 min was lower than that before implementing the procedure(P<0.001),all with time effects(P<0.001).The cuff pressure(maximum value)was the highest under a state of moderate or high cough strength during sputum suction(78.38 ± 12.13 cmH2O),and the lowest at 20 min(21.71 ± 4.80 cmH2O).The average cuff pressure(maximum value)of other nursing procedures was 32.28～50.42 cmH2O,and the average cuff pressure at 20min was 25.03～25.94 cmH2O.3.The cuff pressure during sputum suction(maximum value)at SCSS of 5 was 88.67±8.04 cmH2O.The cuff pressure values were all lower than the normal range in the group with SCSS of 4～5,and the substandard rate in the group with SCSS of 5 was 92.68%.There were group effects,time effects and interaction effects of cough strength on the change of cuff pressure during sputum suction(P<0.001).The cough strength was positively correlated with the substandard cuff pressure(r=0.563,P<0.001).The area under ROC curve was 0.820(P<0.001),with the cutoff value of 3.5,the sensitivity value of 0.716 and the specificity value of 0.847.Conclusions1.The modified cuff pressure measurement method can reduce the loss of cuff pressure compared with the traditional cuff pressure measurement method,and the measurement accuracy is the highest when taking the actual cuff pressure value as the inflating volume.The tapered cuff is more easily affected by air volume,so it is necessary to pay attention to its measurement and correction in clinical practice.2.The four clinical nursing procedures of sputum suction,oral care,atomization inhalation and turning over can all cause different degrees of cuff pressure drop.When the cough strength during sputum suction(SCSS)is greater than or equal to 4,it is recommended to recalibrate the cuff pressure at 10 min after sputum suction. |
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