Evaluation of antihypoxemic maneuvers before tracheal aspiration in mechanically ventilated newborns

Abstract

Periodical tracheal aspiration in mechanically ventilated patients is necessary to remove mucus from the airways. In children and adults, this procedure causes transient hypoxemia, which may be prevented by hyperoxia and/or hyperventilation. These findings, however, have not been sufficiently assessed in newborn infants. Thus we investigated the usefulness of hyperoxia and/or hyperventilation as antihypoxemic maneuvers before tracheal aspiration in newborn infants. Our design was a prospective, randomized, multiple crossover study. The setting was the NICU of a third-level pediatric hospital in Mexico City. Patients included 15 newborn infants under mechanical ventilation. Within a 12-hr period, every patient received, in random order, three antihypoxemic maneuvers during 1 min just before tracheal aspiration: hyperoxia (10% increase of baseline FiO2), hyperventilation (50% increase of ventilator cycling rate), or both. Additionally, a control (sham) maneuver was also applied. Pulse oximeter saturation (SpO2) was recorded before and after each antihypoxemic maneuver, and at 0, 15, 30, 60, and 300 sec after tracheal aspiration. Basal values of SpO2 (81.5 +/- 1.5%) increased with all three antihypoxemic maneuvers (SpO2 over 90%, P <0.05 to P <0.01). Immediately after tracheal aspiration a drop in the SpO2 could be detected in all infants. However, patients receiving hyperoxia showed higher SpO2 values (87.1 +/- 1.8%) than those observed with the sham maneuver (76.9 +/- 2.3%, P <0.01). From this point on, all newborn infants in all conditions (even those with sham maneuver) had spontaneous increments of SpO2 that at 300 sec were again higher than their respective basal values (P <0.05 to P <0.0005). At this time, SpO2 values from following the hyperoxia maneuver were still higher than those following the sham maneuver (P <0.05). Our results show that, similar to what occurs at other ages, tracheal aspiration in mechanically ventilated newborn infants causes transient hypoxemia, which can be partially prevented by previous application of antihypoxemic maneuvers, especially hyperoxia.

Endotracheal Suctioning of the Critically Ill Child

“…37 weeks in 11/15, age range: 1-24 days), three techniques to prevent hypoxemia (hyperoxygenation with 10% above baseline, hyperventilation with 50% increase in rate of inflations, and both) were compared with no maneuver. 36 All three techniques resulted in an initial increase in SpO 2 , which remained above baseline during suctioning only with hyperoxygenation alone. Similarly, this was the only technique in which SpO 2 was significantly higher than the control condition at 0, 1, and 5 minutes postsuctioning.…”

I Recomendação brasileira de fisioterapia respiratória em unidade de terapia intensiva pediátrica e neonatal

“…In NBs, hyperoxia (a 10% increase over baseline fraction of inspired oxygen) led to favorable effects on the reduction of transient hypoxemia resulting from endotracheal aspiration by an open system. (38) Manual restraint maneuvers, through the placement of the hands on the head and feet of NBs in flexed posture, reduced pain scores during the procedure in preterm NBs. (37) The criteria in table 2 are suggested to enhance the safety of the procedure, and they indicate that airway aspiration of intubated NBs, infants, and children be performed for a maximum of 10 seconds (to prevent ventilatory and hemodynamic alterations inherent to disconnecting the patient from the MPV apparatus) and that the vacuum suction pressure should not exceed 360 mmHg.…”

“…(37) Multisensory stimulation does not alter pain scores after endotracheal aspiration in NBs (C). (38) Rationale When the sedation score was evaluated during endotracheal aspiration in children under MPV, it was found that this procedure does not alter the level of sedation previously used. (32) In NBs under MPV, the use of sedation prior to the procedure did not influence pain scores as measured using the Bernese Pain Scale for Neonates (BPSN), Premature Infant Pain Profile (PIPP), and Visual Analogue Scale (VAS).…”

“…Hyperoxia (10% increase over baseline fraction of inspired oxygen) is recommended in preterm NBs to avoid hypoxemia during and after endotracheal aspiration to maintain SpO 2 between 88 and 92% (C). (38) Postural restraint maneuvers are recommended during aspiration procedures in preterm NBs (C). (37)…”

Estudo comparativo entre sistema de aspiração fechado e sistema de aspiração aberto em recém-nascidos mantidos em ventilação mecânica convencional invasiva

“…No estudo apresentado, procuramos descrever detalhadamente toda a seqüência de procedimentos a serem realizados antes, durante e após a aspiração, como: posicionamento do RN em decúbito dorsal com a cabeça na linha média, pré-oxigenação com 10% de FiO 2 acima da basal, seleção apropriada da sonda de aspiração de acordo com o número de cânula endotraqueal e valor de pressão negativa de 15 a 20 cmHg além da duração do procedimento, que foi de 15 segundos (Hodge, 1991;Skov et al, 1992;Wringtson et al,1999;O'Neal et al, 2001;Day et al, 2002;Akgul e Akyolcu, 2002;Morrow et al, 2004;González-Cabello et al, 2005;Morrow e Argent, 2008 (Maggiore et al, 2003). Carlon et al (1987) (Maggiore et al, 2003).…”