Article thumbnail
Location of Repository

End-expiratory lung volume recovers more slowly after closed endotracheal suctioning than after open suctioning : a randomized crossover study

By Amanda Corley, Amy J. Spooner, Adrian G. Barnett, Lawrence R. Caruana, Naomi E. Hammond and John F. Fraser

Abstract

Purpose Endotracheal suctioning causes significant lung derecruitment. Closed suction (CS) minimizes lung volume loss during suction, and therefore, volumes are presumed to recover more quickly postsuctioning. Conflicting evidence exists regarding this. We examined the effects of open suction (OS) and CS on lung volume loss during suctioning, and recovery of end-expiratory lung volume (EELV) up to 30 minutes postsuction. Material and Methods Randomized crossover study examining 20 patients postcardiac surgery. CS and OS were performed in random order, 30 minutes apart. Lung impedance was measured during suction, and end-expiratory lung impedance was measured at baseline and postsuctioning using electrical impedance tomography. Oximetry, partial pressure of oxygen in the alveoli/fraction of inspired oxygen ratio and compliance were collected. Results Reductions in lung impedance during suctioning were less for CS than for OS (mean difference, − 905 impedance units; 95% confidence interval [CI], − 1234 to –587; P < .001). However, at all points postsuctioning, EELV recovered more slowly after CS than after OS. There were no statistically significant differences in the other respiratory parameters. Conclusions Closed suctioning minimized lung volume loss during suctioning but, counterintuitively, resulted in slower recovery of EELV postsuction compared with OS. Therefore, the use of CS cannot be assumed to be protective of lung volumes postsuctioning. Consideration should be given to restoring EELV after either suction method via a recruitment maneuver

Topics: 110310 Intensive Care, intensive care, lung
Publisher: W.B. Saunders Co.
Year: 2012
DOI identifier: 10.1016/j.jcrc.2012.08.019
OAI identifier: oai:eprints.qut.edu.au:55839

Suggested articles

Citations

  1. (2000). A computed tomographic scan assessment of endotracheal suctioning-induced bronchoconstriction in ventilated sheep.
  2. (2001). A lung model evaluation of closed suctioning systems. Acta Anaesthesiol Scand
  3. Acute hemodynamic changes during lung recruitment in lavage and endotoxin-induced ALI. Intensive Care Med
  4. (2008). An introduction to generalized linear models.
  5. (2004). Changes in lung volume with three systems of endotracheal suctioning with and without pre-oxygenation in patients with mild-to-moderate lung failure. Intensive Care Med
  6. (2005). Clinical issues and research in respiratory failure from severe acute respiratory syndrome. Am J Respir Crit Care Med
  7. Closed suctioning system reduces cross-contamination between bronchial system and gastric juices. Anesth Analg 2004; 99:886-892, table of contents
  8. (2001). Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation. Intensive Care Med
  9. (2007). Closed tracheal suction systems versus open tracheal suction systems for mechanically ventilated adult patients. Cochrane Database Syst Rev
  10. Comparison of loss in lung volume with open versus in-line catheter endotracheal suctioning. Pediatr Crit Care Med
  11. (2003). Effects of recruitment maneuvers in patients with acute lung injury and acute respiratory distress syndrome ventilated with high positive end-expiratory pressure. Crit Care Med
  12. (2003). End-expiratory lung impedance change enables bedside monitoring of end-expiratory lung volume change. Intensive Care Med
  13. (1991). Environmental contamination during tracheal suction. A comparison of disposable conventional catheters with a multipleuse closed system device. Anaesthesia
  14. (2003). Estimation of regional lung volume changes by electrical impedance pressures tomography during a pressure-volume maneuver. Intensive Care Med
  15. (2008). Functional residual capacity changes after different endotracheal suctioning methods. Anesth Analg
  16. (2010). lmer: Linear mixed-effects models using S4 classes. R package version 0.999375-35,
  17. (2005). Lung recruitment maneuver depresses central hemodynamics in patients following cardiac surgery. Intensive Care Med
  18. (2003). Lung recruitment manoeuvres are effective in regaining lung volume and oxygenation after open endotracheal suctioning in acute respiratory distress syndrome. Crit Care
  19. (1992). Open up the lung and keep the lung open. Intensive Care Med
  20. (2003). Prevention of endotracheal suctioninginduced alveolar derecruitment in acute lung injury. Am J Respir Crit Care Med
  21. (2007). Regional lung derecruitment after endotracheal suction during volume- or pressure-controlled ventilation: a study using electric impedance tomography. Intensive Care Med
  22. Report of the American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. The Consensus Committee. Intensive Care Med
  23. (2004). Side effects of endotracheal suction in pressure- and volume-controlled ventilation. Chest
  24. (1997). Surfactant dysfunction makes lungs vulnerable to repetitive collapse and reexpansion.
  25. (2009). The assessment of regional lung mechanics with electrical impedance tomography: a pilot study during recruitment manoeuvres. Intensive Care Med
  26. The effect of endotracheal suction on regional tidal ventilation and end-expiratory lung volume. Intensive Care Med
  27. (2005). The impact of closed endotracheal suctioning systems on mechanical ventilator performance. Respir Care

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.