Effects of Suctioning on Mucociliary Transport

Landa, Jose; Kwoka, Mark; Chapman, Gillete A.; Brito, Miguel; Sackner, Marvin A.

doi:10.1378/chest.77.2.202

Cited by 48 publications

(10 citation statements)

References 7 publications

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“…22 This maneuver can injure the tracheal mucosa, 23 decrease lung volume leading to hypoxia, 24 trigger cardiac arrhythmias, 25 and increase intracranial pressure. 26 In addition, the use of blind suctioning has also been associated with further impairment of tracheal mucociliary clearance function 27 together with dislodging emboli of pathogens from the ETT biofilm to the lower airway. 28 Several novel dedicated medical devices have been developed for the specific purpose of ETT cleaning.…”

Section: Discussionmentioning

confidence: 99%

Endotracheal Tubes Cleaned With a Novel Mechanism for Secretion Removal: A Randomized Controlled Clinical Study

et al. 2016

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INTRODUCTION: Intubation compromises mucus clearance, allowing secretions to accumulate inside the endotracheal tube (ETT). The purpose of this trial was to evaluate a novel device for ETT cleaning. We hypothesized that its routine use would reduce tube occlusion due to mucus accumulation, while decreasing airway bacterial colonization. METHODS: Subjects were randomized to either the use of the device every 8 h, or the institutional standard of care (blind tracheal suction) only. ETTs were collected at extubation and analyzed with high-resolution computed tomography (HRCT) for quantification of mucus volume. Microbiological testing was performed on biofilm samples. Vital signs and ventilatory settings were collected at the bedside. In-hospital follow-up was conducted, and a final evaluation survey was completed by respiratory therapists. RESULTS: Seventy-four subjects expected to remain intubated for longer than 48 h were enrolled (77 ETTs, 37 treatment vs 40 controls). Treated tubes showed reduced mucus accumulation (0.56 ؎ 0.12 vs 0.71 ؎ 0.28 mL; P ‫؍‬ .004) and reduced occlusion (6.3 ؎ 1.7 vs 8.9 ؎ 7.6%; P ‫؍‬ .039). The HRCT slice showing the narrowest lumen within each ETT exhibited less occlusion in cleaned tubes (10.6 ؎ 8.0 vs 17.7 ؎ 13.4%, 95% CI: 2-12.1; P ‫؍‬ .007). Data on microbial colonization showed a trend in the treatment group toward a reduced ETT-based biomass of bacteria known to cause ventilator-associated pneumonia. No adverse events were reported. The staff was satisfied by the overall safety and feasibility of the device. CONCLUSION: The endOclear is a safe and effective device. It prevents luminal occlusion, thereby better preserving ETT nominal function.

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Section: Discussionmentioning

confidence: 99%

Endotracheal Tubes Cleaned With a Novel Mechanism for Secretion Removal: A Randomized Controlled Clinical Study

et al. 2016

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“…performed invasive procedure in ventilated newborn infants, and is important to maintain ETT patency and to prevent complications of secretion retention (1,2). It is associated, however, with the potential for significant adverse effects including loss of lung volume, hypoxemia, and localized injury to the tracheobronchial tree (3)(4)(5)(6)(7)(8)(9)(10)(11).…”

Section: E Ndotracheal Tube (Ett) Suction Is the Most Frequentlymentioning

confidence: 99%

Negative Tracheal Pressure During Neonatal Endotracheal Suction

et al. 2008

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Endotracheal tube (ETT) suction is the most frequently performed invasive procedure in ventilated newborn infants and is associated with adverse effects related to negative tracheal pressure. We aimed to measure suction catheter gas flow and intratracheal pressure during ETT suction of a test lung and develop a mathematical model to predict tracheal pressure from catheter and ETT dimensions and applied pressure. Tracheal pressure and catheter flow were recorded during suction of ETT sizes 2.5-4.0 mm connected to a test lung with catheters 5-8 French Gauge and applied pressures of 80 -200 mm Hg. The fraction of applied pressure transmitted to the trachea was calculated for each combination, and data fitted to three nonlinear models for analysis. E ndotracheal tube (ETT) suction is the most frequently performed invasive procedure in ventilated newborn infants, and is important to maintain ETT patency and to prevent complications of secretion retention (1,2). It is associated, however, with the potential for significant adverse effects including loss of lung volume, hypoxemia, and localized injury to the tracheobronchial tree (3-11). The cause of these adverse effects may be the exposure of the tracheobronchial tree to negative pressure (5,(12)(13)(14).The chief determinants of intratracheal pressure during suction are thought to be applied suction pressure (P suction ) and catheter size relative to ETT size (14,15). The effect of suction on intratracheal pressure has been evaluated in vitro and in vivo for adult ETT and catheter sizes (16,17), and in vivo studies have examined the effects of P suction and the relationship between ETT and suction catheter size on changes in oxygenation, respiratory mechanics, and cardiovascular dynamics (5,18,19). Although larger catheters and higher P suction are found to generate lower intratracheal pressure than smaller catheters, the exact relationship between these variables has not been determined (16,17,20).In an in vitro lung model, intratracheal pressure was found to be inversely related to the cross-sectional area between the ETT and catheter for neonatal and pediatric ETT sizes during suction (using an applied pressure of 500 mm Hg) (20). However, this relationship was not mathematically defined. Rosen and Hillard (21) derived an equation to quantify intratracheal pressure in terms of ETT and suction catheter dimensions and applied suction pressure, but this equation did not account for the annular shape of the area between the ETT and catheter and has not been verified empirically (15).The aim of this study was, in an in vitro lung model, to measure intratracheal pressure and catheter gas flow (VЈ catheter ) over the range of clinically used P suction for neonatal ETTs and suction catheters. In addition, we aimed to develop a mathematical model to define the relationship between the intratracheal pressure generated during suction and ETT size, suction catheter size, and P suction . MATERIALS AND METHODSEthical approval is not required for bench-top experiments...

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“…Their airways may be particularly sensitive to insults. Perhaps the endotracheal tube or the suction catheter mechanically irritated the upper airways.7 8 The tubes used were polyvinyl tubes (Portex). It is unlikely that any plasticiser would elute from these fairly firm tubes.…”

Section: Resultsmentioning

confidence: 99%

Bronchial hypersecretion in preterm neonates.

Wong¹,

Beardsmore²,

Meek³

et al. 1982

Archives of Disease in Childhood

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SUMMARY During an 18-month period, 11 pieterm infants with birthweights between 700 and 1560 g (mean 12 kg) developed excessive tracheobronchial secretions during intensive care. No single obstetric factor was incriminated. Copious, viscous, tracheobronchial secretions were noted at about 5 days during mechanical ventilation via endotracheal tube causing recurrent segmental collapse, hypoxia, and hypercapnia (median peak Pco2 13-5 kPa). All infants were treated with frequent bronchial lavages and continued intermittent positive pressure ventilation, together with high concentrations of oxygen. No infant died, but morbidity was high. Tracheostomy was performed on 2 infants (one at age 3 months, because of severe croup) and 2 others had clinical or physiological evidence of upper airways narrowing. Follow-up studies showed that this group had more problems of airways obstruction throughout the first year of life as well as increased lung stiffness. The hypersecretion group showed a higher incidence of chronic lung disease. Likely aetiological factors were sought. Contamination of the mechanical ventilation equipment by detergent and activated glutaraldehyde was found; this could have been a contributory factor.

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Effects of Suctioning on Mucociliary Transport

Cited by 48 publications

References 7 publications

Endotracheal Tubes Cleaned With a Novel Mechanism for Secretion Removal: A Randomized Controlled Clinical Study

Endotracheal Tubes Cleaned With a Novel Mechanism for Secretion Removal: A Randomized Controlled Clinical Study

Negative Tracheal Pressure During Neonatal Endotracheal Suction

Bronchial hypersecretion in preterm neonates.

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