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Abstract
BACKGROUND: Hyperoxygenation and hyperinflation, preferably with a mechanical ventilator, is the most commonly used technique to prevent the adverse effects of open endotracheal suctioning on arterial oxygenation and pulmonary volume. However, limited data are available on the effects of oxygen concentrations < 100% and PEEP with zero end-expiratory pressure (0 PEEP) to improve oxygenation and to maintain adequate ventilation during open endotracheal suctioning. The aim of this study was to analyze the behavior of 
and end-tidal CO2 pressure (
) in open endotracheal suctioning using the 0 PEEP technique with baseline 
(0 PEEP baseline 
) and 0 PEEP + hyperoxygenation of 20% above the baseline value (0 PEEP 
+ 0.20) in critically ill subjects receiving mechanical ventilation.
METHODS: This was a prospective, randomized, single-blind crossover study, for which 48 subjects with various clinical and surgical conditions were selected; of these, 38 subjects completed the study. The subjects were randomized for 2 interventions: 0 PEEP baseline 
and 0 PEEP 
+ 0.20 during the open endotracheal suctioning procedure. Oxygenation was assessed via oxygen saturation as measured with pulse oximetry (
), and changes in lung were monitored via 
using volumetric capnography.
RESULTS: In the intragroup analysis with 0 PEEP baseline 
, there was no significant increase after open endotracheal suctioning in either 
(P = .63) or 
(P = .11). With 0 PEEP 
+ 0.20, there was a significant increase in 
(P < .001), with no significant changes in 
(P = .55). In the intergroup comparisons, there was a significant increase compared to the basal values only with the 0 PEEP + 0.20 method at 1 min after hyperoxygenation (P < .001), post-immediately (P < .001), at 1 min after (P < .001), and at 2 min after open endotracheal suctioning (P < .001).
CONCLUSIONS: The appropriate indication of the hyperinflation strategy via mechanical ventilation using 0 PEEP with or without hyperoxygenation proved to be efficient to maintain 
and 
levels. These results suggest that the technique can minimize the loss of lung volume due to open endotracheal suctioning. (ClinicalTrials.gov registration NCT02440919).
Footnotes
- Correspondence: Jacqueline Rodrigues de Freitas Vianna PT PhD, Av Comandante Salgado, 428 B, Castelo, Batatais, CEP 14300 220, São Paulo, Brazil. E-mail: jacrfvianna{at}uol.com.br
See the Related Editorial on Page 1939
The authors have disclosed no conflicts of interest.
- Copyright © 2020 by Daedalus Enterprises
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