Effectiveness and side effects of closed and open suctioning: an experimental evaluation
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To compare the effectiveness of closed system suctioning (CSS) and open system suctioning (OSS) and the side effects on gas exchange and haemodynamics, during pressure-controlled ventilation (PCV) or continuous positive airway pressure (CPAP).
Bench test and porcine lung injury model.
Twelve bronchoalveolar saline-lavaged pigs.
Research laboratory in a university hospital.
In a mechanical lung, the efficacy of OSS and CSS with 12 and 14 Fr catheters were compared during volume-control ventilation, PCV, CPAP 0 or 10 cmH2O by weighing the suction system before and after aspirating gel in a transparent trachea. Side effects were evaluated in the animals with the same ventilator settings during suctioning of 5, 10 or 20 s duration.
Measurements and results
Suctioning with 12 and 14 Fr catheters was significantly more efficient with OSS (1.9±0.1, 2.8±0.9 g) and with CSS during CPAP 0 cmH2O (1.8±0.2, 4.2±0.5 g) as compared to CSS during PCV (0.2±0.2, 0.8±0.3 g) or CPAP 10 cmH2O (0.0±0.1, 0.7±0.4 g), p<0.01 (means ± SD). OSS and CSS at CPAP 0 cmH2O resulted in a marked decrease in SpO2, mixed venous oxygen saturation and tracheal pressure, p<0.001, but the side effects were considerably fewer during CSS with PCV and CPAP 10 cmH2O, p<0.05.
Irrespective of catheter size, OSS and CSS during CPAP 0 cmH2O were markedly more effective than CSS during PCV and CPAP 10 cmH2O but had worse side effects. However, the side effects lasted less than 5 min in this animal model. Suctioning should be performed effectively when absolutely indicated and the side effects handled adequately.
KeywordsSuctioning Closed system suctioning Airway pressure Gas exchange Acute respiratory distress syndrome (ARDS) Mechanical ventilation
- 2.Deppe SA, Kelly JW, Thoi LL, Chudy JH, Longfield RN, Ducey JP, Truwit CL, Antopol MR (1990) Incidence of colonization, nosocomial pneumonia and mortality in critically ill patients using a Trach Care closed-suction system versus an open-suction system: prospective, randomized study. Crit Care Med 18:1389–1393PubMedGoogle Scholar
- 5.Craig CK, Benson MS, Pierson DJ (1984) Prevention of arterial oxygen desaturation during closed-airway endotracheal suction: effect of ventilator mode. Respir Care 29:1013–1018Google Scholar
- 12.Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R (1994) Report of the American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. The Consensus Committee. Intensive Care Med 20:225–232PubMedGoogle Scholar
- 18.Witmer M, Hess D, Simmons M (1991) An evaluation of the effectiveness of secretion removal with the Ballard closed-circuit suction catheter. Respir Care 36:844–848Google Scholar
- 24.Burton GG, Hodgkin JE, Ward JJ (1997) Respiratory care modalities and equipment. In: Hess DR (ed) Respiratory care: a guide to clinical practice, Lippincott, Philadelphia, pp 600–609Google Scholar
- 25.Pilbeam SP (1998) Airways, circuit changes, medications, positioning and other patient issues. In: Pilbeam SP (ed) Mechanical ventilation: physiological and clinical applications. Mosby, St Louis pp 292–293Google Scholar
- 27.National Research Council (U.S.), Commission on Life Sciences. Institute of Laboratory Animal Resources (1996) Guide for the care and use of laboratory animals. National Academy Press. ISBN 0309053773Google Scholar
- 31.Lumb A (2000) Oxygen. In: Lumb A (ed), Nunn’s applied respiratory physiology. Butterworth-Heinemann, Reed Educational and Professional Publishing, Oxford, pp 265–266, 294–297Google Scholar
- 33.Tabachnick BG, Fidell LS (1989) Profile analysis of repeated measures. In: Tabachnick BG (ed), Using multivariate statistics. Harper Collins, New York, pp 437–505Google Scholar