Frequency and characterization of the use of cuffed tracheal tubes in neonatal and pediatric intensive care units in Brazil

ABSTRACT Objective: To identify the neonatal, pediatric and mixed (neonatal and pediatric) intensive care units in Brazil that use cuffed tracheal tubes in clinical practice and to describe the characteristics related to the use of protocols and monitoring. Methods: To identify the intensive care units in Brazil, the Ministry of Health’s National Registry of Health Facilities was accessed, and information was collected on 693 registered intensive care units. This was an analytical cross-sectional survey conducted through electronic questionnaires sent to 298 neonatal, pediatric and mixed intensive care units in Brazil. Results: This study analyzed 146 questionnaires (49.3% from neonatal intensive care units, 35.6% from pediatric intensive care units and 15.1% from mixed pediatric intensive care units). Most of the participating units (78/146) used cuffed tracheal tubes, with a predominance of use in pediatric intensive care units (52/78). Most of the units that used cuffed tracheal tubes applied a cuff pressure monitoring protocol (45/78). The use of cuff monitoring protocols was observed in intensive care units with a physical therapy service exclusive to the unit (38/61) and in those with a physical therapist present 24 hours/day (25/45). The most frequent cause of extubation failure related to the use of cuffed tracheal tubes in pediatric intensive care units was upper airway obstruction. Conclusion: In this survey, the use of cuffed tracheal tubes and the application of a cuff pressure monitoring protocol was predominant in pediatric intensive care units. The use of a monitoring protocol was more common in intensive care units that had a physical therapist who was exclusive to the unit and was present 24 hours/day.摘要 研究目的：识别巴西境内临床实践中使用带套囊气管导管（cuffed tracheal tubes）的新生儿重症监护病房（neonatal intensive care units）、儿科重症监护病房（pediatric intensive care units）以及混合型（新生儿与儿科）重症监护病房，并描述其与方案应用及监测相关的特征。 研究方法：本研究通过调取巴西卫生部国家卫生设施注册系统，共收集到693家已注册的重症监护病房信息。随后针对巴西境内的298家新生儿、儿科及混合型重症监护病房开展分析性横断面调查，以电子问卷形式收集相关数据。 研究结果：本研究共分析146份有效问卷，其中49.3%来自新生儿重症监护病房，35.6%来自儿科重症监护病房，15.1%来自混合型儿科重症监护病房。参与调研的科室中，78家使用带套囊气管导管，占总受访科室的78/146，其中以儿科重症监护病房的使用占比最高：78家使用带套囊气管导管的科室中有52家来自儿科重症监护病房。在使用带套囊气管导管的科室中，45家应用了套囊压力监测方案，占该类科室的45/78。套囊压力监测方案的应用在配备专属科室物理治疗服务的重症监护病房中更为常见：61家该类科室中，有38家应用了该方案；而在配备全天24小时在岗物理治疗师的科室中，45家该类科室里有25家应用了该方案。在儿科重症监护病房中，与带套囊气管导管使用相关的拔管失败最常见诱因为上气道梗阻。 研究结论：本调查显示，儿科重症监护病房中带套囊气管导管的使用及套囊压力监测方案的应用最为普遍。配备专属科室物理治疗师且全天24小时在岗的重症监护病房，其套囊压力监测方案的应用率更高。