Comparing the effect of using normal saline, N-acetyl cysteine and not using them in endotracheal tube suction on physiologic parameters and the amount of secretions in intubated patients under mechanical ventilation

Abstract

Aims: Today a large number of patients hospitalized in Intensive Care Unit need mechanical ventilation via an artificial air way. Since these patients have endotracheal tube, endotracheal suctioning is necessary for increasing oxygenation, cleaning the airway and keeping it open. But this method consists of various side effects such as increased blood pressure and heart rate and respiratory rate, cyanosis, dizziness and increased intracranial pressure and hypoxia. This study aimed at comparing the effect of using normal saline serum, N-acetyl cysteine and not using them in endotracheal suctioning on physiologic parameters and the amount of secretions in intubated patients under mechanical ventilation. Material & Methods: It was a controlled clinical trial study with random allocation that was performed on 54 intubated patients hospitalized in ICU of health educational centers of Babol Medical Sciences University in 2014. Endotracheal tube suctioning was performed for each patient once without saline, the second time with 3 ml of normal saline and the third time with 2 ml of N-acetyl cysteine. Blood pressure, Heart rate, Respiratory rate, Arterial oxygen saturation were measured and recorded before each stage of suctioning and two and five minutes after that. Amount of secretions was measured after each method of suctioning. Data were analyzed by SPSS16 statistical software, variance analysis with repeated measures, ANOVA and paired t statistical tests. Results: Blood pressure, Heart rate and Respiratory rate were increased after suction in all the three groups, but these changes were higher in the group that received normal saline. Mean decrease of Arterial oxygen saturation was more in the method of receiving normal saline (p<0.05). The amount of secretion was more in the method of receiving N-acetyl cysteine (p=0.004). Conclusions: Endotracheal tube suctioning by using normal saline had more adverse effects on post- suction physiological parameters in compare with the other two methods. Therefore, it is recommended to not use normal saline in endotracheal tube suctioning to the possible extent, and if removing secretions is required, endotracheal N_acetyl cysteine should be used according to the patient's condition