Effects of Combined Tracheal Suctioning and Expiratory Pause: A Crossover Randomized Clinical Trial
Luciane de Fraga Gomes Martins, Wagner da Silva Naue, Amanda Soares Skueresky, Tanara Bianchi, Alexandre Simões Dias, Luiz Forgiarini Jr.
Aspirated secretions, Bronchial hygiene, Endotracheal aspiration, Intensive care unit, Respiratory therapy
Citation Information :
Martins LD, Naue WD, Skueresky AS, Bianchi T, Dias AS, Forgiarini Jr. L. Effects of Combined Tracheal Suctioning and Expiratory Pause: A Crossover Randomized Clinical Trial. Indian J Crit Care Med 2019; 23 (10):454-457.
Aims: Our aim is to compare volume of suctioned secretion, respiratory mechanics, and hemodynamic parameters in intubated patients undergoing closed-system endotracheal suctioning alone (control group) versus closed-system tracheal suctioning with an expiratory pause (intervention group).
Settings and design: Randomized crossover clinical trial.
Materials and methods: Patients who had been on mechanical ventilation for more than 24 hours were randomly assigned to receive closed-system suctioning alone or closed-system suctioning with an expiratory pause on the ventilator. The following variables were evaluated: heart rate, respiratory rate, mean arterial pressure, peripheral arterial oxygen saturation, peak inspiratory pressure, mechanical ventilator circuit pressure during aspiration, exhaled tidal volume, dynamic compliance, resistance, and weight of suctioned secretion.
Statistical analysis: Compared using the paired t-test and general linear model analysis of variance for normally distributed variables (as confirmed by the Kolmogorov-Smirnov test). The Wilcoxon test was used for variables with a nonparametric distribution, while the Chi-square test and Fisher\'s exact test were used for categorical variables.
Results: The sample comprised 31 patients (mean age, 61.1 ± 18.2 years). The amount of secretion suctioned was significantly higher in the intervention group than in the control group (1.6 g vs 0.45 g; p = 0.0001). There were no significant changes in hemodynamic parameters or respiratory mechanics when comparing pre- and postprocedure time points.
Conclusion: The combination of closed-system endotracheal suctioning and an expiratory pause significantly increased the amount of secretion suctioned compared to conventional suctioning without expiratory pause.
Key messages: Combination of closed-system endotracheal suctioning and an expiratory pause significantly increased the amount of secretion suctioned.
Almgren B, Wickerts CJ, Heinonen E, Högman M. Side Effects of Endotracheal Suction in Pressure and Volume-Controlled Ventilation. Chest. 2001;125:1077–1080.
Bassi GL, Saucedo L, Marti JD, Rigol M, Esperatti M, Luque N, et al. Effects of duty cycle and positive end-expiratory pressure on mucus clearance during mechanical ventilation. Crit Care Medicine. 2012;40:895–902.
Benjamin RG, Chapman GA, Kim CS. Removal of bronchial secretions by two-phase gas-liquid transport. Chest. 1989;95:658–663.
Kim CS, Rodriguez CR, Eldridge MA. Criteria for mucus transport in the airways by two-phase gas-liquid flow mechanism. J Appl Physiol. 1986;60:901–907.
Amato MB, Carvalho CR, Isola A. Mechanical ventilation in Acute Lung Injury (ALI)/Acute Respiratory Discomfort Syndrome (ARDS). J Bras Pneumol. 2007;33(Suppl 2S):S119–S127.
Bhowmik A, Chahal K, Austin G. Improving mucociliary clearance in chronic obstructive pulmonary disease. Respir Med. 2009;103:496–502.
Ntoumenopoulos G, Presneill JJ, McElholum M. Chest physiotherapy for the prevention of ventilator-associated pneumonia. Intensive Care Med. 2002;28:850–856.
Copnell B, Tingay DG, Kiraly NJ, Sourial M, Gordon MJ, Mills JF, et al. A comparison of the effectiveness of open and closed endotracheal suction. Intensive Care Med. 2007;33:1655–1662.
Lindgren S, Odenstedt H, Olegard C, Sondergaard S, Lundin S, Stenqvist O. Regional lung derecruitment after endotracheal suction during volume- or pressure-controlled ventilation: a study using electric impedance tomography. Intensive Care Med. 2007;33:172–180.
Combes P, Fauvage B, Oleyer C. Nosocomial pneumonia in mechanically ventilated patients: a prospective randomised evaluation of the Stericath closed suctioning system. Intensive Care Med. 2000;26:878–882.
Weitl J, Betterstetter H. Indications for the use of closed endotracheal suction: artificial respiration with high positive end-expiratory pressure. Anaesthesist. 1994;43:359–363.
Cereda M, Villa F, Colombo E. Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation. Intensive Care Med. 2001;27:648–654.
Maggiore SM, Lellouche F, Pigeot J, Taille S, Deye N, Durrmeyer X, et al. Prevention of Endotracheal Suctioning-induced Alveolar Derecruitment in Acute Lung Injury. Am J Respir Care Med. 2003;167:1215–1224.
Craig KC, Benson MS, Pierson DJ. Prevention of arterial oxygen desaturation during closed-airway endotracheal suction: effect of ventilator mode. Respir Care. 1984;29:1013–1018.
Ragnarsdóttir M, Kristjánsdóttir Á, Ingvarsdóttir I, Hannesson P, Torfason B, Cahalin L. Short-term changes in pulmonary function and respiratory movements after cardiac surgery via median sternotomy. Scand Cardiovasc J. 2004;38(1):46–52.
Ciesla ND. Chest physical therapy for patients in the intensive care unit. Phys Ther. 1996;76(6):609–625.
Selsby D, Jones JG. Some physiological and clinical aspects of chest physiotherapy. Br J Anaesth. 1990;64(5):621–631.
Restrepo RD, Brown JM. 2nd, Hughes JM. Endotracheal Suctioning of Mechanically Ventilated Patients with Artificial Airways 2010. Respir Care. 2010;55:758–764.
Maggiore SM, Lellouche F, Pignataro C, Girou E, Maitre B, Richard JC, et al. Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice. Respir Care. 2013;58(10):1588–1597
Lindgren S, Almgren B, Högman M, Lethvall S, Houltz E, Lundin S, et al. Effectiveness and side effects of closed and open suctioning: an experimental evaluation. Intensive Care Med 2004;30(8):1630–1637.
American Association for Respiratory Care. Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care 2010;55(6):758–764.
Tingay DG, Copnell B, Grant CA, Dargaville PA, Dunster KR, Schibler A. The effect of endotracheal suction on regional tidal ventilation and end-expiratory lung volume. Intensive Care Med 2010;36(5):888–896.
Maggiore SM, Volpe C. Endotracheal suctioning in hypoxemic patients. Réanimation 2011;20(1):12–18.