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Research ArticleOriginal Research

Physiologic Effects of Nasal Aspiration and Nasopharyngeal Suctioning on Infants With Viral Bronchiolitis

Coral N Ringer, Rebecca J Engberg, Kristen E Carlin, Craig D Smallwood and Robert M DiBlasi
Respiratory Care July 2020, 65 (7) 984-993; DOI: https://doi.org/10.4187/respcare.07269
Coral N Ringer
Clinical Effectiveness, Quality and Safety Support, Seattle Children’s Hospital, Seattle, Washington.
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  • For correspondence: [email protected]
Rebecca J Engberg
Pediatric Intensive Care Unit, Seattle Children’s Hospital, Seattle, Washington.
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Kristen E Carlin
Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington.
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Craig D Smallwood
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts.
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Robert M DiBlasi
Respiratory Care Department, Seattle Children’s Hospital, Seattle, Washington and Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, Washington.
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Abstract

BACKGROUND: There is limited evidence supporting an optimum method for removing mucus from the airways of hospitalized infants with bronchiolitis. This study was designed to evaluate short-term physiologic effects between nasal aspiration and nasopharyngeal suctioning in infants.

METHODS: Sixteen infants requiring hospitalization for supportive management of bronchiolitis were instrumented with transcutaneously measured partial pressure of carbon dioxide (Embedded Image) and Embedded Image monitoring. Electrical impedance tomography (EIT) was used to estimate changes in inspiratory and end-expiratory lung volume loss and recovery. Subjects were suctioned with both nasal aspiration and nasopharyngeal suctioning methods in a randomized order (8 received nasal aspiration followed by nasopharyngeal suctioning, and 8 received nasophayrgeal suctioning followed by nasal aspiration). Noninvasive gas exchange and EIT measurements were obtained at baseline (pre-suction) and at 10, 20, and 30 min following each suctioning intervention. Sputum mass was obtained following suctioning, and clinical respiratory severity scores, before and after suctioning, were computed.

RESULTS: There were no differences in inspiratory EIT (P = .93), change in end-expiratory lung impedance (ΔEELI; P = .53), Embedded Image (P = .41), Embedded Image (P = .88), heart rate (P = .31), or breathing frequency (P = .15) over the course of suctioning between nasal aspiration and nasopharyngeal suctioning. Sputum mass (P = .14) and clinical respiratory score differences before and after suctioning (P = .59) were not different between the 2 suctioning interventions. Sputum mass was not associated with ΔEELI at 30 min for nasal aspiration (ρ = 0.11, P = .69), but there was a moderate positive association for nasopharyngeal suctioning (ρ = 0.50, P = .048).

CONCLUSIONS: Infants with viral bronchiolitis appeared to tolerate both suctioning techniques without adverse short-term physiologic effects, as indicated by the unchanged gas exchange and estimated lung volumes (EIT). Nasopharyngeal suctioning recovered 36% more sputum than did nasal aspiration and there was moderate correlation between sputum mass and end-expiratory lung impedance change at 30 minutes post-suction with nasopharyngeal that was not present with nasal aspiration. It is possible that a subset of patients may benefit from one type of suctioning over another. Future research focusing on important outcomes for suctioning patients with bronchiolitis with varying degrees of lung disease severity is needed.

  • bronchiolitis
  • suctioning
  • nasopharyngeal
  • olive tip
  • nasal suctioning
  • electrical impedance tomography

Footnotes

  • Correspondence: Coral Ringer MN RN CPN, Seattle Children’s Hospital, 4800 Sand Point Way N.E., Seattle, WA 98105. E-mail: coral.ringer{at}seattlechildrens.org
  • Mr DiBlasi has disclosed relationships with Dräger Medical, Vapotherm, Mallinckrodt Medical, and Vero Biotech. Dr Smallwood disclosed relationships with Ventec Life Systems and Capsule Technology. The other authors have disclosed no conflicts of interest.

  • Copyright © 2020 by Daedalus Enterprises
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Respiratory Care: 65 (7)
Respiratory Care
Vol. 65, Issue 7
1 Jul 2020
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Physiologic Effects of Nasal Aspiration and Nasopharyngeal Suctioning on Infants With Viral Bronchiolitis
Coral N Ringer, Rebecca J Engberg, Kristen E Carlin, Craig D Smallwood, Robert M DiBlasi
Respiratory Care Jul 2020, 65 (7) 984-993; DOI: 10.4187/respcare.07269

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Physiologic Effects of Nasal Aspiration and Nasopharyngeal Suctioning on Infants With Viral Bronchiolitis
Coral N Ringer, Rebecca J Engberg, Kristen E Carlin, Craig D Smallwood, Robert M DiBlasi
Respiratory Care Jul 2020, 65 (7) 984-993; DOI: 10.4187/respcare.07269
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Keywords

  • Bronchiolitis
  • suctioning
  • nasopharyngeal
  • olive tip
  • nasal suctioning
  • electrical impedance tomography

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