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Anästhesiol Intensivmed Notfallmed Schmerzther 2012; 47(4): 232-237
DOI: 10.1055/s-0032-1310411
Fachwissen
Anästhesiologie
© Georg Thieme Verlag Stuttgart · New York

Geblockte Tuben bei Kindern – Rationaler und sicherer Einsatz

Safe use of cuffed tracheal tubes in children
Markus Weiss
,
Andreas Gerber
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Publication History

Publication Date:
13 April 2012 (online)

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Zusammenfassung

Der Einsatz geblockter Tuben bei Säuglingen und Kindern hat in den letzten 5 Jahren eine weltweite Akzeptanz erfahren. Die Vorteile der geblockten Tuben – insbesondere die nahezu immer passende Tubusgrößenwahl sowie die zuverlässige schonende Abdichtung der kindlichen Trachea – vereinfachen die endotracheale Intubation und die Beatmung beim Kind beträchtlich und kompensieren für allfällige Mehrkosten der geblockten verglichen mit ungeblockten Tuben.

Die Befürchtungen, dass Blockmanschetten bei kleinen Kindern zu Larynxschäden führen, haben sich bei korrekter Anwendung geeigneter Tuben als nichtig erwiesen. Voraussetzungen für den Einsatz gecuffter Tuben sind ein adäquat ausgestalteter geblockter Kindertubus, eine überprüfte Tubusgrößenwahlempfehlung sowie das Vorhandensein von Cuffdruck-Messgeräten. Regeln für den sicheren Einsatz geblockter Tuben bei Kindern sind die Sicherstellung einer deutlichen Luftleckage bis ≤ 20 cmH2O Inspirationsdruck im ungeblockten Zustand, die Cuffdruck-Begrenzung bis maximal 20 cmH2O Cuffdruck, sowie die Vermeidung von Cuff-Unterdruck beim liegenden Tubus.

Abstract

In the last 5 years the use of cuffed tracheal tubes in infants and children has become popular worldwide and is accepted by major medical authorities. The advantages of cuffed tracheal tubes in smaller children – in particular the almost 100% chance to insert the right sized tracheal tube at the first attempt and their reliable sealing characteristics within the trachea – makes tracheal intubation and ventilation considerable easier and safer. This certainly compensates for the higher cost of cuffed compared to uncuffed tracheal tubes.

The fear that cuffed tracheal tubes cause increased laryngeal damage in small children could not be confirmed, if adequately designed, cuffed tracheal tubes are correctly used. Conditions for the safe use of cuffed tubes in children are the availability of an adequately designed cuffed tube with a proofed recommendation for tube size selection and cuff pressure monitoring. The following rules must be fulfiled when cuffed tubes in children using are: confirmation of an air leak < 20 cmH2O inspiratory pressure with the cuff not inflated, cuff pressure limitation at 20 cmH2O and the avoidance of negative cuff pressures, resulting in sharp, cutting edges of the cuff membrane within the trachea.

Kernaussagen

  • Tuben mit Blockmanschetten sind bei Säuglingen, Kleinkindern und Kindern sicher und vorteilhaft bei korrekter Anwendung geeigneter Tubusprodukte.

  • Geblockte Tuben können gemäß aktueller Evidenzlage sicher und ohne Atemwegsschäden bei Säuglingen, Kleinkindern und Vorschulkindern für Kurzzeitintubationen eingesetzt werden, wenn die entsprechenden Voraussetzungen und Regeln vorhanden sind bzw. eingehalten werden.

  • Voraussetzungen für den Einsatz geblockter Tuben sind:

    • adäquat ausgestalteter Kindertubus mit Blockmanschette

    • überprüfte Tubusgrößenwahlempfehlung des Herstellers

    • Cuffdruckkontrolle

  • Ein adäquat ausgestalteter geblockter Tubus für Kinder umfasst:

    • anatomisch orientierte Tubustiefenmarkierung

    • kurzstreckiger, distal platzierter HVLP-Cuff

    • subglottisch cuff-freier Tubusschaft

  • Regeln für den sicheren Einsatz geblockter Tuben bei Kindern sind:

    • Sicherstellung einer deutlichen Luftleckage bis ≤ 20 cm H2O Inspirationsdruck im ungeblockten Zustand

    • Cuffdruckbegrenzung bis maximal 20 cm H2O Cuffdruck

    • Wenn die Manschette ausnahmsweise nicht geblockt ist, soll sie zur Umgebung offen sein (kein Unterdruck)

  • Atemwegsschäden bei Kindern im Zusammenhang mit geblockten Tuben sind hauptsächlich auf übergroße, überdimensionierte geblockte Tuben oder auf Überblähung der Blockmanschette zurückzuführen.

  • Können Vorraussetzungen und Regeln für den sicheren Einsatz eines geblockten Tubus beim Kind nicht gewährleistet oder eingehalten werden, so sollen weiter ungeblockte Tuben zum Einsatz kommen und auf die Vorteile des geblockten Tubus beim Kind zwangsläufig verzichtet werden.

Schlüsselwörter:

Intubation - Kinder - Tubus - Blockmanschette - Komplikationen

Key words:

intubation - children - tubes - cuff - complications

Ergänzendes Material

 

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