Changes in lung volume with three systems of endotracheal suctioning with and without pre-oxygenation in patients with mild-to-moderate lung failure
To compare changes in lung volume, oxygenation, airway pressure, and hemodynamic effects induced by suctioning with three systems in critically ill patients with mild-to-moderate lung disease, and also to evaluate the effects of hyperoxygenation applied prior to the maneuver as suggested by some guidelines.
Prospective crossover study.
General intensive care department of a university-affiliated hospital.
Ten mechanically ventilated patients with mild-to-moderate acute respiratory failure.
Patients were ventilated in volume control mode with a mean tidal volume of 490±88 ml, PEEP 7±4 cmH2O and FiO2 0.36±0.05. Suctioning was performed sequentially with a quasi-closed system, with an open system 10 min later, and finally with a closed system. Thereafter, pure oxygen was applied for 2 min and the whole suctioning sequence was repeated in reverse order.
Measurements and main results
Patients’ mean PaO2/FiO2 ratio was 273±28 mmHg. The reductions in lung volume during suctioning were similar with the quasi-closed (386±124 ml) and closed system (497±338 ml), but significantly higher with the open system (1281±656 ml, P=0.022). We found no significant hemodynamic adverse effects, and no significant SpO2 reductions with all the studied suctioning techniques. Pre-oxygenation with pure oxygen did not induce additive effects in lung volume changes. With and without pre-oxygenation, lung volume returned to baseline in every patient within 10 min.
Suctioning with closed and quasi-closed systems reduces the substantial losses in lung volume observed with the open system. Nevertheless, in patients without severe lung disease these changes were transient and rapidly reversible.
KeywordsEndotracheal suctioning Mechanical ventilation Acute respiratory failure Health technology assessment
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