A recruitment breath manoeuvre directly after endotracheal suction improves lung function: An experimental study in pigs

Abstract

BackgroundAtelectasis occurs after a well performed endotracheal suction. Clinical studies have shown that recruitment manoeuvres added after endotracheal suction during mechanical ventilation restore lung function. Repetitive lung over-distension is, however, harmful for the lung, and the effects of adding a larger breath, recruitment breath, directly after repeated endotracheal suction were therefore investigated.MethodsTwelve healthy anaesthetized pigs were randomized into two groups: one without and one with a recruitment breath manoeuvre (RBM), i.e. a breath 15 cmH2O above inspiratory pressure for 10 s during pressure-controlled ventilation. The pigs were suctioned every hour for 4 hours with an open suction system.ResultsAt the end of the study there was a statistically significant difference between the group given RBM and that without with respect to PaCO2, tidal volume (VT), and compliance (Crs). Without RBM, the PaCO2 increased from 4.6±0.4 to 6.1±1.5 kPa, VT decreased from 345±39 to 247±71 mL, and Crs decreased from 28±6 to 18±5 mL/cmH2O. There was no change in PaCO2 or Crs when a RBM was given. Morphological analysis revealed no differences in aeration of apical and central lung parenchyma. In the basal lung parenchyma there were, however, greater areas with normal lung parenchyma and less atelectasis after RBM.ConclusionsAtelectasis created by endotracheal suction can be opened by inflating the lung for a short duration with low pressure, without over-distension, immediately after suction.

Differences in delivery of respiratory treatments by on-call physiotherapists in mechanically ventilated children: a randomised crossover trial

“…It would theoretically be advantageous to apply manual lung inflations prior to returning patients to the ventilator, rather than finishing a treatment with an endotracheal suction. Suction as the final treatment component may leave some atelectatic areas that could take considerable time to re-inflate when the patient was returned to the mechanical ventilator [16]. These differences between NRP and SRP may help to explain why respiratory outcomes tended to favour SRP treatments [3].…”

A comparison of the effects of manual hyperinflation and ventilator hyperinflation on restoring end-expiratory lung volume after endotracheal suctioning: A pilot physiologic study

“…Previous studies [14,34,35] have recommended a recruitment manoeuvre during or post-ES to maintain oxygenation and prevent sustained lung collapse. Our results support the implementation of either MHI or VHI as a recruitment manoeuvre post-ES in this study population.…”