Comparison of loss in lung volume with open versus in-line catheter endotracheal suctioning

Abstract

The most significant loss in lung volume during suctioning occurs primarily during ventilator disconnection. Hence, open catheter suction results in greater lung volume loss when compared with in-line catheter suction. We suggest that in-line catheter suction is preferable, especially in patients with significant lung disease and who require high positive end-expiratory pressures, to avoid alveolar derecruitment and exacerbating hypoxemia during endotracheal tube suctioning.

Paediatric lung recruitment: a review of the clinical evidence

“…[48][49][50] One paediatric study compared open and closed suction and the impact on lung volume. 51 Choong and colleagues demonstrated using inductive plethysmography that the greatest loss of lung volume is related to disconnection from the circuit and subsequently recommended the use of closed suction units. 51 However a number of studies have cautioned clinicians about negative pressures associated with the use of closed suction units and a reduction in secretion clearance particularly in paediatrics.…”

“…51 Choong and colleagues demonstrated using inductive plethysmography that the greatest loss of lung volume is related to disconnection from the circuit and subsequently recommended the use of closed suction units. 51 However a number of studies have cautioned clinicians about negative pressures associated with the use of closed suction units and a reduction in secretion clearance particularly in paediatrics. [52][53][54] Consequently, the use of closed suction systems, at least in the paediatric population, remains questionable.…”

“…In addition, saline instillation exacerbates gas maldistribution and worsens de-recruitment by increasing threshold opening pressures. [51][52] Recent studies measured the impact of various suctioning methods and modes of ventilation and found that irrespective of ventilation mode, or whether open or closed suctioning was used, a significant loss of FRC occurred. [48][49][50][51] In a study by Lindgren et al, FRC as measured by EIT decreased by 58±24% of baseline after disconnection of the endotracheal tube and a further 22±10% during open suction itself.…”

“…[51][52] Recent studies measured the impact of various suctioning methods and modes of ventilation and found that irrespective of ventilation mode, or whether open or closed suctioning was used, a significant loss of FRC occurred. [48][49][50][51] In a study by Lindgren et al, FRC as measured by EIT decreased by 58±24% of baseline after disconnection of the endotracheal tube and a further 22±10% during open suction itself. 50 It is probable that some form of recruitment manoeuvre may be necessary to attenuate the impact of LPVS, particularly after circuit disconnection and the application of suction.…”

Comparison of a Closed with an Open Endotracheal Suction: Costs and the Incidence of Ventilator-associated Pneumonia

“…Because the desired PEEP is not maintained in the patient's lungs, small airways and alveoli may collapse. Unstable patients may immediately deteriorate due to hypoxemia 7 . Another method of endotracheal suctioning is using a multiple-use closed suction system.…”