Chest
Volume 113, Issue 5, May 1998, Pages 1335-1338
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Clinical Investigations in Critical Care
Effects of Tracheal Suctioning on Respiratory Resistances in Mechanically Ventilated Patients

https://doi.org/10.1378/chest.113.5.1335Get rights and content

Objective

To evaluate the effects of tracheal suctioning (TS) on respiratory resistances in sedated critical care patients receiving mechanical ventilation (MV).

Setting

Surgical ICU of Bichat Hospital, Paris.

Patients and participants

Thirteen sedated critical care patients receiving MV for various conditions.

Measurements and results

Airway resistances (R1), airway and pulmonary resistances (R2), and intrinsic positive end-expiratory pressure (PEEPint) were measured according to the end-inspiratory and end-expiratory occlusion methods before and after TS. R1 and R2 increased by 49.1% and 46.3%, respectively, 0.5 min after TS (p<0.01) but returned to baseline values at 1 min without any change thereafter. PEEPint decreased progressively following TS to reach a significant level (–13.3%) at 10 min (p<0.05) and was persistently reduced at 30 min (p<0.01). Nine patients received 500 pg of inhaled albuterol before another suctioning procedure. R1 and R2 decreased by 11.5% and 9.9%, respectively, 20 min after inhalation (p<0.05), but the R1 and R2 initial increase following TS did not differ between the two suctioning procedures.

Conclusions

TS evokes only a transient bronchoconstrictor response, but thereafter, does not reduce respiratory resistances below presuctioning values. However, the decrease of PEEPint following TS suggests an increase of expiratory flow. Effective β2-adrenergic receptor blockade fails to suppress the TS-induced bronchoconstrictor response.

Section snippets

MATERIALS AND METHODS

Thirteen ICU patients requiring MV for various conditions were studied. The investigation was conducted according to the local ethics committee guidelines, and informed consent was obtained from each patient or relative.

All patients were sedated with IV midazolam and fentanyl. They were well adapted to the ventilator and no triggering activity was detected.

MV was performed through a cuffed translaryngeal tube or through a tracheostomy tube. MV was achieved in a volumecontrolled mode with a

RESULTS

Demographic data regarding the patients in the study are summarized in Table 1.

R1 increased from 7.6±5.0 to 10.4±7.0 cm H2O/L/s (p<0.01) and R2 from 10.9±5.2 to 15.3±7.1 cm H2O/L/S (p<0.01) 0.5 min after tracheal suction (Table 2). R1 and R2 returned to baseline values 1 min following suction without any change thereafter. There was no change in the (R2-R1)/R2 ratio during the 30 min recording, suggesting that the increase in R1 paralleled this in R2.

PEEPint dropped from 3.70±4.10 cm H2O at

DISCUSSION

In this study, we found that TS evoked a potent bronchoconstrictor response for a short period. Indeed, R1 and R2 increased >45%, 30 s following this procedure but returned to baseline values 1 min later. More surprisingly, respiratory resistances did not decrease below presuctioning values thereafter, as could have been expected, even on the late recordings (Table 2). Dohi and Gold13 reported a similar evolution of respiratory resistances following mechanical stimulation of the trachea with a

ACKNOWLEDGMENTS

The authors wish to thank Dr. Eric Maury (Medical ICU, Saint-Antoine Hospital, Paris, France) for his critical review of the manuscript.

REFERENCES (21)

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