TaperGuard+Story+

,关于微量误吸,The TaperGuard Story 1.0,TaperGuard Story 目的,Covidien | December 25, 2017 | Confidential For Internal Use Only,2 |,Clinical Evidence,Clinical Application,TaperGuardTG EVAC,Economic Impact,Scientific Platform,一个基本问题：,微量误吸在OR和ICU中是不是一个普遍存在，又带来严重并发症的问题？,4 |,误吸及微量误吸在OR/ICU,我们知道微量误吸的存在吗？,误吸后有哪些并发症,有没有文献来证明误吸的确实存在,如何来减少在OR/ICU中的PPC/PIPC发生,内容,Covidien | 10 June 2010 | 6,口/ 口咽 呼吸支持设备和附件的污染胃部细菌的过度生长口咽分泌物和胃部内容物受损的黏膜清除气管导管的生物聚结医务人员的传播以前的肺疾病“口咽腔和胃液的分泌物是主要的细菌进入肺内的主要通道，也是 误吸/微量误吸发生的重要原因。,误吸/微量误吸 - 风险因素,Covidien | 10 June 2010 | 7,声门持续处于开放状态细菌通过分泌物作为载体 迁移进入气管分泌物池位置高于气管套囊,“口咽腔和胃液的分泌物是主要的细菌进入肺内的主要通道，也是误吸/微量误吸发生的重要原因。,误吸/微量误吸 - 风险因素,目前大家的习惯是怎么样的 ?,在一些医院的日常工作,90以上的国内医院,手指触摸按压测试,手持压力表,Covidien | 10 June 2010 | 9,常见的套囊压力问题,套囊压力cmH2O,关于泄漏实验Asai, 2001: Cuff at 40 cmH20; 10 mls fluid in model trachea5分钟内液体渗漏: 2.4-9.2 mls (4 不同的插管)类似的结果在内部和非印刷的外部研究,Covidien | 10 June 2010 | 10,套囊漏气 !Young P, Rollinson M, Downward G, Henderson S液体通过气管导管套囊流入气管内实验British Journal of Anaesthesia 1997; 78: 557-562Oikkonen M, Aromaa U液体渗漏在低压气管套囊的实验Anaesthesia 1997; 52: 567-569目前PVC 套囊材料:典型的套囊壁的折叠现象 ( 所有的高容量低压套囊 )声门下分泌物通过流入气管的通道VAP 的主要原因,套囊漏气 !,December 25, 2017 | Confidential,11 |,December 25, 2017 | Confidential,12 |,Micro-aspration微量误吸,为什么误吸和微量误吸会发生？,Air Seal.Fluid Seal.,Covidien | December 25, 2017 | Confidential For Internal Use Only,Covidien Respiratory & Monitoring Solutions | December 25, 2017 | Confidential,15 |,皱褶和通道导致了误吸/微量的发生,1. Dullenkopf et al. Intensive Care Med. 2003;29:1849-1853.,CT image of an inflated ETT cuff in a trachea model1,LEFT: Full cross section ofintubated model trachea,RIGHT: Enlargement of region demonstrating a cuff fold and channel,微量误吸和呼吸机相关性肺炎的关系1-5,1. Mahul et al. Intensive Care Med. 1992;18(1):20-25. 5. Metheny et al. Crit Care Med. 2006;34(4):1007-1015.2. Estes et al. Intensive Care Med. 1995;21(4):365-383.6. Kollef et al. Chest. 1999;116(5):1339-1346. 3. Safdar et al. Respir Care. 2005;50(6):725-739.7. Hussain et al. Anaesth Intensive Care 2003;21:272-6.4. Chastre et al. Am J Respir Crit Care Med. 2002;165(7):867-903.,细菌，分泌物 (e.g. HCl, bile),在插管套囊周围的微量误吸,聚集,肺损伤,& VAP,Covidien | December 25, 2017 | Confidential For Internal Use Only,Covidien Respiratory & Monitoring Solutions | December 25, 2017 | Confidential,18 |,Covidien Respiratory & Monitoring Solutions | December 25, 2017 | Confidential,19 |,Covidien Respiratory & Monitoring Solutions | December 25, 2017 | Confidential,20 |,在使用高容量低压气管导管，微量误吸是普遍的现象,“Extensive folding of cuff material” containing secretions is seen at all cuff pressures (25100 cmH2O).Seegobin et al. Br Med J. 1984;288:965-968.“high-volume, low-pressure (HVLP) cuffs were introduced. . these have failed to demonstrate effective prevention of leakage in vitro and in vivo.” Dullenkopf et al. Intensive Care Med. 2003;29:1849-1853.Microaspiration found in 100 percent of general endotracheal anesthetics.Seegobin et al. Can Anaesth Soc J. 1986;33:273-279.,Covidien Respiratory & Monitoring Solutions | December 25, 2017 | Confidential,21 |,微量误吸在ICU也是普遍被发现的现象，并且并发VAP的发生,Metheny el al found evidence of microaspiration in 88.9% of ICU patients even with head of bed elevation and oral care in place.Only 1% of these microaspiration events were observed, the majority were “silent” microaspiration events.Investigator found that microaspiration was on of the most important independent risk factors for pulmonary complications. (p Tracheal diameter 封闭带:Cuff diameter = Tracheal diameter eliminating excess cuff material locally,Mallinckrodt TaperGuard ETT,Covidien Respiratory & Monitoring Solutions | December 25, 2017 | Confidential,37 |,关键信息,新的 TaperGuard气插导管有着独特的锥形套囊设计。这项技术相比高容量低压力套囊的桶状设计更能有效提高气道的封闭性能。TaperGuard套囊是将其套囊近端的直径设计成大于正常成人气管的直径。TaperGuard套囊的直径从近端到远端（靠近肺部）逐渐减小，套囊的外形类似于锥体。独特的锥形设计可以使套囊的直径从近端至远端都契合气管的直径。,CCI 现场动物实验演示在Airways workshop,1 hr after Taperguard intubation 2 hrs,Covidien Respiratory & Monitoring Solutions | December 25, 2017 | Confidential,40 |,Covidien Respiratory & Monitoring Solutions | December 25, 2017 | Confidential,41 |,FDA 510 批准,Covidien Respiratory & Monitoring Solutions | December 25, 2017 | Confidential,43 |,Mallinckrodt Evac significantly reduces early and late VAP,Statistically significant for early-onset and late-onset VAP.No significant differences in duration of MV or ICU mortality.,Covidien | December 25, 2017 | Confidential For Internal Use Only,Lacherade et al. AJRCCM 2010,Subglottic secretion drainage with integrated suction line,Subglottic space,Covidien Respiratory & Monitoring Solutions | December 25, 2017 | Confidential,46 |,Covidien Respiratory & Monitoring Solutions | December 25, 2017 | Confidential,47 |,临床文献,Covidien Respiratory & Monitoring Solutions | December 25, 2017 | Confidential,48 |,小结,误吸/微量误吸导致广泛的肺部并发症和疾病的存在 导管套囊，是防止误吸的第一线位置新的套囊技术减少误吸及微量误吸的发生.,SCCM: Bench comparison of ETTs with SSD,SCCM 4