Endotracheal suctioning: from principles to practice

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

doi:10.1007/s00134-004-2238-0

Cited by 48 publications

(45 citation statements)

References 29 publications

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“…With open suction, lung volume changes were unaffected by catheter size or suction pressure. 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).…”

Section: Discussionsupporting

confidence: 86%

“…Larger catheters, that occlude more of the ETT lumen, have been shown in vitro to generate high negative airway pressures during both open and closed suction (15)(16)(17). In adults, it is recommended that the diameter of the suction catheter should be less than half that of the ETT (35).…”

Section: Discussionmentioning

confidence: 99%

“…At least in vitro, suction catheter size and suction pressure have been implicated in determining tracheal pressure during suction (15)(16)(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).…”

Section: E Ndotracheal Tube (Ett) Suction Is Performed Periodicallymentioning

confidence: 99%

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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: 86%

Section: Discussionmentioning

confidence: 99%

Section: E Ndotracheal Tube (Ett) Suction Is Performed Periodicallymentioning

confidence: 99%

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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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“…With 12 and 10 Fr suction catheters, mucous is suctioned efficiently but the 8 Fr SC is not as effective [4]. In our study, the 8 Fr SC only generated an air flow of 8 l.min )1 .…”

Section: ó 2008 the Authorscontrasting

confidence: 54%

Tracheal pressures during open suctioning*

Vanner

Bick

2008

Anaesthesia

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Summary The purpose of this bench‐top study was to determine the subatmospheric tracheal pressures that could be generated by different sizes of suction catheters when placed into the different sizes of tracheal tubes encountered in adult anaesthetic practice. Five sizes of suction catheter were studied from 8 to 16 Fr and five sizes of tracheal tubes from 5 to 9 mm internal diameter. We found that the larger suction catheters generated potentially dangerous levels of subatmospheric pressure. If the size of suction catheter was limited so that the ratio of the outside diameter of the suction catheter to the inside diameter of the tracheal tubes was 0.5 or less, tracheal pressures were not more than 2 mmHg subatmospheric. We were able to recommend sizes of suction catheter to use for each size of tracheal tube.

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“…Airway pressures during open suction are a function of catheter size, and the difference in cross-sectional area between the ETT and the catheter (23)(24)(25). Flow between the ETT and catheter is predominantly laminar during open suction (23), but during closed suction, the dynamic circuit pressure and gas flow may lead to turbulent flow within this space increasing resistance and resulting in reduced tracheal pressures.…”

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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Endotracheal suctioning: from principles to practice

Abstract: Applied clinically, these results indicate that intrapulmonary pressure changes generated by the endotracheal suctioning of intubated neonates are likely to be considerable, possibly translating into loss of lung volume.

Cited by 48 publications

References 29 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

Tracheal pressures during open suctioning*

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

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