Decreasing adverse effects of endotracheal suctioning during mechanical ventilation by changing practice

Background: Little is known about incidence and risk factors of endotracheal suctioninginduced adverse effects. The usefulness of suctioning guidelines has not been assessed. Our goal was to determine the incidence and risk factors of endotracheal suctioning-induced complications, and to evaluate if the application of practice guidelines could help to reduce their incidence.

Methods: This was a prospective before and after study in 147 mechanically ventilated patients. During a 3-month period, suctioning adverse effects were recorded daily, for all patients (period I, 79 patients, 4506 suctioning procedures). Then, practice guidelines were implemented and, one year later, the same adverse effects were collected for a second 3-month period (period II, 68 patients, 4994 procedures).

Results: In period I, suctioning-associated adverse effects occurred frequently. The more frequent were oxygen desaturation (patients: 46.8%; procedures: 6.5%), and hemorrhagic secretions (patients: 31.6%; procedures: 4%), followed by blood pressure changes (patients: 24.1%; procedures: 1.6%) and heart rate modifications (patients: 10.1%; procedures: 1.1%). After guidelines implementation, all complications together were reduced (patients: 42.6% vs 59.5%; procedures: 4.9% vs 12.4%, p<0.05), as well as each one taken separately. PEEP > 5 cmH₂O was an independent risk factor for oxygen desaturation, while receiving suctioning procedures > 6/day was a risk factor for desaturation and hemorrhagic secretions. Period II was independently associated with a reduced rate of complications.

Conclusions: Endotracheal suctioning frequently induces adverse effects. Technique, frequency of suctioning and high PEEP are risk factors for complications. Their incidence can be reduced by the implementation of practice guidelines.