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目的 检验急性呼吸窘迫综合征 (ARDS)儿童俯卧位可导致气管内插管 (ETT)向头部方向明显移位的假说。设计 回顾性研究胸片和患儿病例记录。地点 一所儿童医院的儿童重症监护病房。测量和主要结果 常规对ARDS患儿分别于俯卧位之前和俯卧位后即刻拍胸片。根据测量的胸廓内气管长度和ETT的胸段长度计算俯卧位后ETT移动情况。 14例患儿进行了 15次成对的胸片检查并评估。本组女 7例 ,男 7例 ,年龄 2个月～ 18岁。俯卧位后所有患儿均出现不同程度 (占胸廓长度的 10 %～ 5 7% ,P <0 0 0 1)ETT向头部方向移位。平均移动幅度为 34% +16 % ,提示如果在俯卧位前ETT顶端深度不超过胸段气管的 1/ 3,则俯卧位后ETT顶端将滑入颈部气管。结论 (1)俯卧位使气管内插管向头部方向移位。 (2 )为了防止俯卧位后ETT滑入颈部气管 ,俯卧位前ETT顶端深度应大于胸段气管长度的 1/ 3。 (3)当俯卧位前ETT深度未超过胸段气管的 1/ 3,俯卧位后应立即拍胸片以确保ETT的位置安全是很重要的。
Objectives To test the hypothesis that the prone position of children with acute respiratory distress syndrome (ARDS) can lead to significant head-end displacement of the endotracheal tube (ETT). Design retrospective study of chest and child case records. Location Children’s intensive care unit at a children’s hospital. MEASUREMENTS AND MAIN RESULTS Conventional radiographs of chest radiographs were performed immediately before and after prone position on children with ARDS. ETT movement was calculated from the measured tracheal length in the thorax and the thoracic length of the ETT. Fourteen children underwent 15 paired chest radiographs and evaluated. The group of female 7 cases, 7 males, aged 2 months to 18 years. All patients in the prone position showed varying degrees (10% ~ 57% of the thoracic length, P <0.01) ETT shifted to the head direction. The mean range of motion was 34% + 16%, suggesting that the tip of the ETT will slide into the neck trachea after the prone position if the ETT tip depth in the prone position does not exceed 1/3 of the thoracic trachea. Conclusions (1) The prone position displaces the endotracheal tube toward the head. (2) In order to prevent the prone ETT from sliding into the neck trachea, the depth of the ETT tip in the prone position should be greater than one-third of the thoracic tracheal length. (3) When the ETT depth before the prone position does not exceed 1/3 of the thoracic trachea, it is important to take the chest radiograph immediately after the prone position to ensure the ETT position is safe.