Effect of endotracheal suction on lung dynamics in mechanically-ventilated paediatric patients

Morrow, Brenda; Futter, Merle; Argent, Andrew C.

doi:10.1016/s0004-9514(06)70047-2

Cited by 55 publications

(50 citation statements)

References 22 publications

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“…This finding is consistent with a study of oxygenation and hemodynamic changes with suction in ventilated children (4) but is somewhat surprising in light of in vitro studies (15,17). In contrast, in another pediatric study catheter size was implicated in reduction in dynamic compliance after suction (19). The suction pressure in this study was 360 mm Hg (48 kPa), higher than in our study or that of Singh et al (4).…”

Section: Discussionsupporting

confidence: 92%

The Effect of Suction Method, Catheter Size, and Suction Pressure on Lung Volume Changes During Endotracheal Suction in Piglets

et al. 2009

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ABSTRACT:We aimed to identify the effect of suction pressure and catheter size on change in lung volume during open and closed endotracheal suction. Anesthetized piglets (n ϭ 12) were intubated with a 4.0-mm endotracheal tube. Lung injury was induced with saline lavage. Three suction methods (open, closed in-line, and closed with a side-port adaptor) were performed in random order using 6, 7, and 8 French gauge (FG) E ndotracheal tube (ETT) suction is performed periodicallyin patients receiving mechanical ventilation, to maintain a patent airway and facilitate ventilation. Although necessary, it is associated with adverse sequelae including atelectasis, hypoxia, and cardiovascular instability (1-4), attributed in part to loss of lung volume. Volume loss can arise from breaking the ventilator circuit for "open" suction and aspiration of gas after application of negative pressure. Closed suction techniques, performed without disconnecting the ventilator circuit, have been widely adopted to reduce the adverse effects of suction (5).Two closed suction techniques are available: in-line systems, in which a suction catheter, enclosed in a plastic sheath, is incorporated into the ventilator circuit; and side-port adaptors, Y-shaped connectors placed between the ETT and the ventilator circuit, through which a suction catheter is passed. Few studies have compared the two methods, and there is little evidence to support the use of one over the other (6 -8). Both techniques have been shown to result in greater physiologic stability in neonates (9,10), and less loss of lung volume in adults (7,11) and children (12) than open suction, although large volume losses have been recorded with both closed and open methods (7,12,13). In the only neonatal study to date comparing lung volume changes, there was no difference in volume loss between open and closed suction during either conventional or high-frequency oscillatory ventilation (HFOV), and wide variation in losses with both methods (14).The contribution to volume loss of factors other than suction method remains to be elucidated. At least in vitro, suction catheter size and suction pressure have been implicated in determining tracheal pressure during suction (15-17), the presumed precursor to volume loss. Whether tracheal pressure changes result in clinically observable effects is unclear (4,18 -20) and there is no consensus on appropriate catheter sizes or suction pressures for clinical use in children or neonates (21)(22)(23)(24)(25)(26)(27). No studies have investigated the impact of these factors on lung volume changes.The aim of this study was to investigate the effect of suction method (open, closed in-line, and closed with a side-port adaptor), catheter size, and suction pressure on lung volume changes during endotracheal suction. Comparisons were made during both conventional, time-cycled pressure-limited ventilation (TCPLV) and HFOV. MATERIALS AND METHODSThe study procedures were approved by the Murdoch Childrens Research Institute Animal Ethics Committee. It was...

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Section: Discussionsupporting

confidence: 92%

The Effect of Suction Method, Catheter Size, and Suction Pressure on Lung Volume Changes During Endotracheal Suction in Piglets

et al. 2009

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“…In the clinical setting, airway pressure and V T are likely to be influenced by the volume and consistency of mucus. Secretions adhering to the ETT can cause considerable narrowing of the ETT lumen (21,22), which could result in greater loss of pressure and V T during suction, whereas secretions entering the catheter will tend to inhibit a fall in pressure (26). However, suction in the absence of secretions can occur in clinical practice (26) and may occur toward the end of the procedure when secretions have been cleared, especially with multiple passes of the catheter.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Closed Endotracheal Suction on Ventilation During Conventional and High-Frequency Oscillatory Ventilation

et al. 2009

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ABSTRACT:In newborn infants, closed endotracheal tube (ETT) suction may reduce associated adverse effects, but it is not clear whether ventilation is maintained during the procedure. We aimed to determine the effect of ETT size, catheter size, and suction pressure on ventilation parameters measured distal to the ETT. Suction was performed on a test lung, ventilated with conventional (CMV) and high-frequency oscillatory ventilation (HFOV) using ETT sizes 2.5-4.0 mm, catheter sizes 5-8 French gauge (Fr), and suction pressures 80 -200 mm Hg. Tracheal and circuit peak inspiratory pressure, positive end-expiratory pressure, and tracheal tidal volume (V T ) were recorded for each suction episode. During both CMV and HFOV, tracheal pressures and V T were considerably reduced by suctioning; this reduction was dependent on the combination of ETT, catheter, and suction pressure. Loss of V T , inflation pressure (CMV), and pressure amplitude (HFOV) occurred primarily with insertion of the catheter, and loss of end-expiratory pressure (CMV) and mean tracheal pressure (HFOV) occurred with the application of suction. Circuit pressures were reduced to lesser degree. We conclude that airway pressures and V T are not maintained during closed endotracheal suction with either CMV or HFOV, and choice of equipment and settings will affect the degree of interruption to ventilation. (Pediatr Res 66: 400-404, 2009) E ndotracheal tube (ETT) suction is performed periodically on infants receiving mechanical ventilation to clear secretions from the ETT and airway. Although necessary, it is associated with adverse effects including atelectasis, hypoxemia, and cardiovascular instability, partly attributable to loss of airway pressure and interruption of ventilation (1-5). Closed suction, performed without disconnection from respiratory support, has been shown to reduce adverse effects (6 -8), but whether ventilation is maintained during closed suction has not been demonstrated in a neonatal population.With adult-sized ETTs, airway pressure has been shown to decrease during closed suction and concerns have been raised about the potential for very large negative airway pressures during the procedure (4,9,10). However only one study has quantified pressure and tidal volume (V T ) changes during closed suction with neonatal equipment (11). Using an in vitro model, a considerable reduction in airway pressures and V T was demonstrated, particularly when a large catheter relative to the ETT was used. However, the authors did not report results using 5 or 7 French gauge (Fr) suction catheters, nor did they measure the effect of varying the suction pressure.Airway pressures during closed suction are influenced by ventilation mode in adult models (4,10), but this effect has not been studied using neonatal ventilators. Of particular interest is the performance of closed suction catheters during highfrequency oscillatory ventilation (HFOV), because closed suction is generally recommended for patients receiving this ventilation mode (12,13).This study ai...

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“…An improvement in Wang's score in all children with bronchiolitis (100%) after being treated with actual techniques of chest physical therapy (PSE and CRR) was found in a Postiaux's et al 10 study, but without a control group. Another study found an initial increase in airway resistance and a reduction of the late auto PEEP by 13%, which would be indicative of a reduction hyperinflation 22 . We have assumed, thus, an improvement in the resistance with an increase by 50% after suctioning the upper airways because infants, until the sixth month of life, present as nose breathers.…”

Section: Sample Sizementioning

confidence: 92%

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

Gomes¹,

Postiaux²,

Medeiros³

et al. 2012

Rev. bras. fisioter.

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Objective: To evaluate the effectiveness of chest physical therapy (CP) in reducing the clinical score in infants with acute viral bronchiolitis (AVB). Methods: Randomized controlled trial of 30 previously healthy infants (mean age 4.08 SD 3.0 months) with AVB and positive for respiratory syncytial virus (RSV), evaluated at three moments: at admission, then at 48 and 72 hours after admission. The procedures were conducted by blinded assessors to each of three groups: G1 -new Chest Physical therapy-nCPT (Prolonged slow expiration -PSE and Clearance rhinopharyngeal retrograde -CRR), G2 -conventional Chest Physical therapy-cCPT (modified postural drainage, expiratory compression, vibration and percussion) and G3 -aspiration of the upper airways. The outcomes of interest were the Wang's clinical score (CS) and its components: Retractions (RE), Respiratory Rate (RR), Wheezing (WH) and General Conditions (GC). Results:The CS on admission was reduced in G1 (7.0-4.0) and G2 (7.5-5.5) but was unchanged in G3 (7.5-7.0). We observed a change 48 hours after hospitalization in G1 (5.5-3.0) and G2 (4.0-2.0) and in 72 hours, there was a change in G1 (2.0-1.0). Conclusion: The CP was effective in reducing the CS in infants with AVB compared with upper airway suction only. After 48 hours of admission, both techniques were effective and nCPT techniques were also effective in the 72 hours after hospitalization compared with cCPT techniques.Trial Registration NCT00884429-www.clinicaltrials.gov.Keywords: respiratory suncytial virus; bronchiolitis; physical therapy. ResumoObjetivo: Avaliar a efetividade da fisioterapia respiratória na redução do escore clínico em lactentes com bronquiolite viral aguda (BVA). Métodos: Ensaio controlado randomizado de 30 lactentes (média de idade 4,08±3,12 meses) com BVA, previamente hígidos, com vírus sincicial respiratório (VSR) positivo, avaliados em três momentos: admissão, 48 e 72 horas, antes e após os procedimentos por avaliadores cegos, em três grupos: G1 -técnicas atuais de fisioterapia (expiração lenta e prolongada e desobstrução rinofaríngea retrógrada), G2 -técnicas convencionais de fisioterapia (drenagem postural modificada, compressão expiratória, vibração e percussão) e G3 -aspiração de vias aéreas superiores por meio do escore clínico de Wang e seus componentes: retrações (RE), frequência respiratória (RR), sibilos (WH) e condições gerais (GC). Resultados: O escore clínico de Wang (CS) no momento admissão, no G1, reduziu de 7,0-4,0; no G2, de 7,5-5,5 e no G3 de 7,5-7,0, não apresentando alteração. No momento 48 horas, também houve alteração tanto no G1 (5,5-3,0) quanto no G2 (4,0-2,0) e, em 72 horas, apenas no G1 (2,0-1,0). Conclusão: A fisioterapia respiratória foi efetiva na redução do escore clínico em lactentes com BVA quando comparada com a aspiração isolada das vias aéreas na admissão. No momento 48 horas, ambas as técnicas foram efetivas, sendo que as técnicas atuais foram efetivas também nas 72 horas após a internação, comparada às técnicas convencionais.Registro de Ensa...

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Effect of endotracheal suction on lung dynamics in mechanically-ventilated paediatric patients

Cited by 55 publications

References 22 publications

The Effect of Suction Method, Catheter Size, and Suction Pressure on Lung Volume Changes During Endotracheal Suction in Piglets

The Effect of Suction Method, Catheter Size, and Suction Pressure on Lung Volume Changes During Endotracheal Suction in Piglets

The Effects of Closed Endotracheal Suction on Ventilation During Conventional and High-Frequency Oscillatory Ventilation

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

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