Open and Closed Endotracheal Suction Systems Divergently Affect Pulmonary Function in Mechanically Ventilated Subjects.
BACKGROUND: In mechanically ventilated subjects, intra-tracheal secretions can be aspirated with either open suction systems (OSS) or closed suction systems (CSS). In contrast to CSS, conventional OSS require temporarily disconnecting the patient from the ventilator, which briefly diminishes PEEP an...
| Publicado en: | Respiratory Care Vol. 66; no. 5; pp. 785 - 793 |
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| Autores principales: | , , , , , , |
| Formato: | research tables/charts randomized controlled trial Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
May2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=150127060&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 150127060 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: May2021 vid: 66 iid: 5 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 150127060 150127060 150127060 10.4187/respcare.08511 150127060 ppf: 785 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Open and Closed Endotracheal Suction Systems Divergently Affect Pulmonary Function in Mechanically Ventilated Subjects. aug: au: Raimundo, Rodrigo Daminello Sato, Monica Akemi da Silva, Talita Dias de Abreu, Luiz Carlos Valenti, Vitor Engracia Riggs, Daniel William Carll, Alex Perrow affil: Laboratório de delineamento de estudos e escrita científica, Faculdade de Medicina do ABC, Santo Andre, Sao Paulo, Brazil sug: subj: Suctioning, Endotracheal Methods Suctioning, Endotracheal Adverse Effects Lung Physiopathology Cardiopulmonary Physiology Evaluation Respiration, Artificial Ventilator Patients Human Intensive Care Units Quasi-Experimental Studies Crossover Design Randomized Controlled Trials Airway Resistance Heart Rate Arterial Pressure Aspiration Regression Lung Injury Prevention and Control Lung Injury Etiology Middle Age Male Female Descriptive Statistics Middle Aged: 45-64 years Male Female ab: BACKGROUND: In mechanically ventilated subjects, intra-tracheal secretions can be aspirated with either open suction systems (OSS) or closed suction systems (CSS). In contrast to CSS, conventional OSS require temporarily disconnecting the patient from the ventilator, which briefly diminishes PEEP and oxygen supply. On the other hand, CSS are more expensive and less effective at aspirating secretions. Thus, it was hypothesized that the 2 procedures differentially affect pulmonary and cardiovascular parameters after suction. METHODS: Subjects in the ICU (N = 66) were quasi-randomized for initial treatment with OSS or CSS in a crossover design. To compare the potential for these suction systems to compromise cardiorespiratory stability, changes in cardiopulmonary physiology were assessed from before to just after use of each suction system (three 10-s aspirations). RESULTS: For most pulmonary and cardiovascular parameters (ie, peak inspiratory pressure, airway resistance, pressure plateau, heart rate, and arterial pressures), the effects of aspiration inversely correlated with baseline values for that parameter, with a similar regression slope between suction systems. However, when controlling for baseline values, OSS caused significantly greater increases in airway resistance and peak inspiratory pressure (P < .001 and < .01 vs CSS, respectively). CONCLUSIONS: Elevated airway resistance prior to endotracheal suction may justify use of a CSS and contraindicate a conventional OSS in mechanically ventilated subjects. Adoption of this approach into clinical guidelines may prevent suction-induced pulmonary injury in subjects, especially for those with underlying diseases involving increased airway resistance or increased alveolar pressure. (ClinicalTrials.gov registration: NCT03256214.) pubtype: Academic Journal doctype: research tables/charts randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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