Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: a prospective randomised controlled trial

Leur, Johannes P. Van de; Zwaveling, JH; Loef, Bert G.; Schans, Cees P. van der

doi:10.1007/s00134-003-1798-8

Cited by 8 publications

(10 citation statements)

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“…Most studies concerning airway suctioning have been dedicated to its mechanics and complications. [15][16][17][18][19] While the question of when to suction remains unanswered, [20][21][22] some authors 8,9 have suggested that analysis of ventilator curves might predict the presence of retained secretions, whereas Branson, in a review on secretion management, highlighted the need for more reliable detection methods. 20 In a recent editorial, Marini referred to acoustic monitoring of airway sounds to improve the timing of suctioning and to avoid unnecessary suctioning and the related risks.…”

Section: Discussionmentioning

confidence: 99%

Tracheal Secretion Management in the Mechanically Ventilated Patient: Comparison of Standard Assessment and an Acoustic Secretion Detector

et al. 2011

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BACKGROUND: Standard indications for endotracheal suctioning are often based on clinical judgment on the deterioration of the patient's condition, and/or routine suctioning. TBA Care is a secretion detector that analyses airway sounds and indicates the need for suctioning. OBJECTIVE: To determine the efficacy of TBA Care in detecting retained secretions, compared to standard indications. METHODS: We conducted a prospective randomized trial with 72 general intensive care unit patients randomized at intubation into 2 groups, differing only in suctioning indications. The control group indications were at least 3 scheduled suctionings per day or were clinically driven. The secretion-detector group indications were device signal or clinically driven. At each suctioning session we recorded the indication for suctioning and the amount of secretions removed. Patients were followed until intensive care unit discharge or extubation. Diagnosis of ventilatorassociated pneumonia was confirmed via microbiological analysis of suctioned secretions. RE-SULTS: We analyzed 1,705 suctionings in the control group and 1,354 in the secretion-detector group. The secretion-detector group had fewer suctionings per day (3.9 ؎ 2.3 vs 4.8 ؎ 1.2, P ‫؍‬ .002) and a lower rate of unnecessary suctionings (4% vs 12%, P < .001). In the secretion-detector group, 97% of the suctionings were performed following the signal from the TBA Care device. In the control group, clinical deterioration (65%) was the most frequent indication for suctioning. The incidence of ventilator-associated pneumonia was similar in the groups. CONCLUSIONS: TBA Care seems to give valid and timely indications for suctioning, anticipating clinical deterioration due to secretion retention and reducing unnecessary suctionings. (ClinicalTrials.gov registration NCT00932776.)

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Section: Discussionmentioning

confidence: 99%

Tracheal Secretion Management in the Mechanically Ventilated Patient: Comparison of Standard Assessment and an Acoustic Secretion Detector

et al. 2011

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“…11,12 The commonly used 5-mm bronchofiberscope is equivalent to the triple-lumen catheter, so the VSSS represents an alternative to the bronchofiberscope.…”

Section: Comparison Of the Vsss And The Bronchofiberscopementioning

confidence: 99%

Laboratory Test of a Visual Sputum Suctioning System

Lv¹,

Wu²,

Guo

et al. 2013

Respir Care

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BACKGROUND: Conventional sputum suctioning is a routine clinical practice, but complications may arise from the blind manipulation of the catheter. Recently, a visual sputum suctioning system (VSSS) was developed, and we tested this new system in a laboratory setting. METHODS: We used coagulant concentrations of 1.5% and 3.0% to simulate mucus and sputum. Conventional singlelumen and triple-lumen catheters were inserted separately into a beaker for sputum suctioning (15 s, 200 mm Hg). A micro-imaging fiber was integrated into the triple-lumen catheter to create the VSSS. The single-lumen catheter and the VSSS were inserted separately into the mouth cavity, the nasal cavity, the tracheostomy tube, and the endotracheal tube of a human analog model for further comparisons. RESULTS: As the suction channel of the triple-lumen catheter was reduced by 46.8%, the amount of simulant it suctioned was significantly less than that suctioned by the single-lumen catheter. However, under real-time guidance, the VSSS suctioned more simulant than the conventional single-lumen catheter in the human analog model. CONCLUSION: Sputum suctioning with the VSSS was feasible. Because of its real-time imaging guidance, the efficiency of the VSSS procedure was greater than that of the conventional single-lumen catheter. Therefore, this system may provide a new platform for sputum suctioning.

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“…15 Therefore, the recommendation of shallow suctioning as a standard of care, 4 especially with closed suction methods, may be much less effective and may predispose the intubated and mechanically ventilated patient to increased risk of tube occlusion, may have the capacity to "blow" secretions away from the suction catheter (trigger inspiratory flow bias from ventilator breaths), unless the patient has a cough response (unlikely, as it is a shallow suctioning), and may in part explain why clinicians deviate from this clinical guidance. 6,9,15,16 Open or closed suctioning, when combined with deep or shallow suctioning, 8 may impact on treatment efficacy. For example, the shallow suctioning method may be more effective for secretion clearance when combined with open suctioning (ventilator circuit disconnection should result in an expiratory flow bias, due to the elastic recoil from passive expiration), as opposed to when combined with closed suctioning, where the negative pressure from the closed suction generated within the ventilator circuit may trigger ventilator breaths and generate an inspiratory flow bias (dependent on ventilator mode) and move or "blow" airway secretions away from the suction catheter tip.…”

mentioning

confidence: 99%

“…The clinical relevance of these findings must be extrapolated on the basis of current practice. In the methods reported by Maggiore et al, 17 these were based on evidence published 16 after the trial had been conducted. Maggiore et al 17 advocate that the shallow endotracheal suctioning method 16 would be less deleterious, compared with standard or deep endotracheal suctioning.…”

mentioning

confidence: 99%

Endotracheal Suctioning May or May Not Have an Impact, But It Does Depend on What You Measure!

Ntoumenopoulos

2013

Respir Care

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Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: a prospective randomised controlled trial

Cited by 8 publications

References 0 publications

Tracheal Secretion Management in the Mechanically Ventilated Patient: Comparison of Standard Assessment and an Acoustic Secretion Detector

Tracheal Secretion Management in the Mechanically Ventilated Patient: Comparison of Standard Assessment and an Acoustic Secretion Detector

Laboratory Test of a Visual Sputum Suctioning System

Endotracheal Suctioning May or May Not Have an Impact, But It Does Depend on What You Measure!

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