Effect of Minimally Invasive Endotracheal Tube Suctioning on Suction-Related Pain, Airway Clearance and Airway Trauma in intubated Patients: A Randomized Controlled Trial

Abstract

Background: Due to the frequency and risks associated with endotracheal suctioning, there is a need to examine clinical practice critically and identify clinical research to guide practice. Correct technique and preparation by the clinicians can assist to reduce the risks of adverse events and the level of discomfort for the patients. Objectives: The current study aimed to investigate the effects of routine versus the minimally invasive endotracheal tube suctioning procedure on suction-related pain, airway clearance and airway trauma in patients who were intubated. Methods: In this randomized clinical trial, 64 patients with intubation in the intensive care units (ICUs) of Alzahra Hospital, Isfahan, Iran, were randomly allocated to minimally invasive endotracheal tube suctioning (MIETS) and routine endotracheal tube suctioning (RETS) groups. Pain intensity was assessed immediately before, immediately after and 10 minutes after endotracheal tube suctioning (ETS). Airway clearance was defined by numbers of suctioning and airway trauma noted after suctioning. The Chisquare test, independent T-test, and repeated measures analysis of variance were performed to analyze the data. Results: There was no significant difference in the number of suctions needed to effectively clear airway between the two groups. No significant differences were observed in the pain score changes during the three-time measurements in the MIETS group. However, in the RETS group the increase of pain scores were statistically significant during the three-time measurements. In addition, the number of airway traumatization was significantly higher in the RETS group. The number of medications used as a pain relief during 10 minutes after the ETS was significantly higher in the RETS group. Conclusions: The results of the study suggest that using MIETS instead of RETS caused a lower incidence of airway traumatization and lower suction-related pain intensity. In addition, MIETS was sufficiently effective, the same as RETS, to remove airway secretions. Hence, MIETS may be useful to reduce the complications of ETS as long as being effective to remove airway secretions.

Effect of Simulation-Based Suction Education on the Knowledge and Performance of Pediatric Intensive Care Unit Nurses

“…20% of the painful procedures of the neonatal population are endotracheal suctioning. In nurses' decision to perform ETT suctioning, personal experiences and patient factors play a crucial role [4]. Patients who did not receive anesthesia or sedative drugs before suctioning had a higher pain score [5].…”

“…The mean suction pressure is approximately twice that of the standard, and in only 67% of cases, patients receive pre-oxygenation [9]. Unlike usual suctioning, ETT suctioning lessens the risk of airway injury and pain [4].…”