Chest
Clinical Investigations in Critical CareBedside Detection of Retained Tracheobronchial Secretions in Patients Receiving Mechanical Ventilation: Is It Time for Tracheal Suctioning?
Section snippets
Materials and Methods
The study was performed in a 14-bed medical ICU of Saint-AntoineHospital, a 946-bed university hospital. It was conducted according tothe local Ethics Committee Guidelines for Human Research. Informedconsent was obtained from each patient or the nearest next of kin.
All consecutive patients receiving MV with the Cesar ventilator (CFPO;Paris, France) or the T-Bird ventilator (SEBAG; Pantin, France)were included. Both ventilators display real-time flow-volume loops ontheir monitor screen. Either
Results
Sixty-six patients were studied. Their characteristics arepresented in Table 1. Thirty-nine patients (59%) had TS2 > 0.5 mL (group 2). The meanvolume of removed secretions by TS2 was 2.6 ± 2.5 mL (range, 0.6 to12 mL) in group 2, and 0.1 ± 0.1 mL (range, 0.0 to 0.5 mL) in group1. The mean time elapsed between TS1 and TS2 was 122 ± 38 min.
Variations of Ppeak, Vt,Spo2, and Ramsay score between TS1and TS2 did not differ between the two groups (Table 2). However, group 2 had a sawtooth pattern (82%
Discussion
In this prospective study, we observed that the presence of asawtooth pattern on the flow-volume loop displayed on the monitorscreen of the ventilator or the presence of respiratory sounds over thetrachea accurately indicates the presence of retained tracheobronchialsecretions in ICU patients receiving MV, and may indicate the need for TS. Conversely, modifications of the respiratory pattern, Spo2, or Ramsay score fail toidentify patients with retained secretions.
The sawtooth pattern is a
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