Side Effects of Endotracheal Suction in Pressure- and Volume-Controlled Ventilation

doi:10.1378/chest.125.3.1077

Chest

Volume 125, Issue 3, March 2004, Pages 1077-1080

https://doi.org/10.1378/chest.125.3.1077 Get rights and content

Study objectives

To investigate the effects of endotracheal suction in volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) with an open suction system (OSS) or a closed suction system (CSS).

Design

Randomized comparison.

Setting

Animal research laboratory.

Patients

Twelve healthy anesthetized pigs.

Interventions

The effects of endotracheal suction during VCV and PCV with tidal volume (Vt) of 14 mL/kg were compared. A 60-mm inner-diameter endotracheal tube was used. Ten-second suction was performed using OSS and CSS with 12F and 14F catheters connected to − 14 kPa vacuum.

Measurements and results

Thirty minutes after suction in PCV, Vt was still decreased by 27% (p < 0.001), compliance (Crs) by 28% (p < 0.001), and Pao₂ by 26% (p < 0.001); Paco₂ was increased by 42% (p < 0.0001) and venous admixture by 158% (p = 0.003). Suction in VCV affected only Crs (decreased by 23%, p < 0.001) and plateau pressure (increased by 24%, p < 0.001). The initial impairment of gas exchange following suction in VCV was no longer statistically significant after 30 min.

Conclusions

In conclusion, endotracheal suction causes lung collapse leading to impaired gas exchange, an effect that is more severe and persistent in PCV than in VCV.

Section snippets

Materials and Methods

Twelve healthy anesthetized pigs of mixed breed (Hampshire, Yorkshire, and Swedish native breed) with a body weight ranging from 25 to 35 kg were investigated. The experimental protocol was examined and approved by the local Ethics Committee for Animal Experiments, Uppsala, Sweden. The study was performed in accordance with the recommendations of the Swedish National Board for Laboratory Animals.

Effect of Suction During PCV and VCV Using a 14F OSS

In PCV 1 min after suction, MPAP (p = 0.009) and venous admixture (p < 0.001) were increased, and Pao₂ (p < 0.001), Vt (p < 0.001), and Crs (p < 0.001) were decreased. After 30 min, these changes were still significant; in addition, Paco₂ had increased (p < 0.001). In VCV 1 min after suction, MPAP (p = 0.004), venous admixture (p = 0.001), and Pplat (p < 0.001) were increased, and Pao₂ (p < 0.001) and Crs (p < 0.001) were decreased. Thirty minutes after suction, these variables had returned to

Discussion

We have shown that gas exchange and lung mechanics were more negatively affected by endotracheal suction in PCV than in VCV. Most of the negative effects of suction remained after 30 min in PCV, but this was not the case when VCV was used. One possible explanation is that in VCV, where the volume of each breath is the same, there is a small recruitment with each successive breath. However, in VCV, the changes in both Crs and Pplat remained 30 min after suction; this may indicate partial lung

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Cited by (27)

Knowledge and practice of intensive care nurses for endotracheal suctioning in a teaching hospital in western Turkey
2017, Intensive and Critical Care Nursing
Citation Excerpt :
The open suction system is only used once with the ventilator disconnected, whereas the closed suction system is used more than once and permits suction without disconnection of the ventilator (Çelik and Kanan, 2006; Morrow, 2007; Sole et al., 2015; Yazdannik et al., 2013). When not performed properly, ETT suctioning may lead to serious complications such as arterial and venous desaturation, cardiac arrhythmia, cardiac arrest, atelectasis, bronchospasm, microbial contamination of the lower respiratory airways, ventilator-associated pneumonia, anxiety and dyspnea (Almgren et al., 2004; Argent, 2009; Floyd, 2011; Irajpour et al., 2014; Sole et al., 2015; Yazdannik et al., 2013). It has been shown that most of the ICU nurses act according to their own personal experience in their suctioning practice, rather than relying on scientific evidence (Ansari et al., 2012; Day et al., 2001, 2002; Kelleher and Andrews, 2008; Özden and Görgülü, 2012; Sole et al., 2003, 2015).
This study was conducted to determine intensive care nurses’ knowledge and practice levels regarding open system endotracheal suctioning and to investigate if there is a relationship between nurses’ demographic characteristics and their knowledge and practice.
The study was conducted as a cross-sectional and non-participant structured observational design. Data were collected using a 45-item structured and self-administered questionnaire and a 31-item observational checklist. The study sample included 72 nurses.
Three adult intensive care units in a teaching hospital.
The nurses’ mean scores of knowledge and practice were 23.79 ± 3.83 and 12.88 ± 2.53. Their level of knowledge was very good in 59.7%, good in 34.7%, and the level of practice was fair in 79.2% and good in 18.1%. The relationship between the type of unit and the nurses’ knowledge scores was statistically significant (p = 0.013). The correlation between the nurses’ scores of knowledge and practice was not statistically significant (r = 0.220; p = 0.063).
This study suggests that the knowledge level of most of the nurses was good and their practice level was fair. Intensive care nurses must perform suctioning procedures safely and effectively to ensure delivery of quality of care and eliminate complications.
End-expiratory lung volume recovers more slowly after closed endotracheal suctioning than after open suctioning: A randomized crossover study
2012, Journal of Critical Care
Citation Excerpt :
Therefore, our findings add weight to the argument for performing a lung recruitment maneuver, regardless of which suction method is used. A recruitment maneuver can be performed during or after suctioning to maintain or restore EELV [3,6,20,21] and minimize the deleterious effects of suctioning such as alveolar derecruitment and atelectasis. Such maneuvers should be performed with care because adverse events, although mostly transient, can occur [21–25].
Endotracheal suctioning causes significant lung derecruitment. Closed suction (CS) minimizes lung volume loss during suction, and therefore, volumes are presumed to recover more quickly postsuctioning. Conflicting evidence exists regarding this. We examined the effects of open suction (OS) and CS on lung volume loss during suctioning, and recovery of end-expiratory lung volume (EELV) up to 30 minutes postsuction.
Randomized crossover study examining 20 patients postcardiac surgery. CS and OS were performed in random order, 30 minutes apart. Lung impedance was measured during suction, and end-expiratory lung impedance was measured at baseline and postsuctioning using electrical impedance tomography. Oximetry, partial pressure of oxygen in the alveoli/fraction of inspired oxygen ratio and compliance were collected.
Reductions in lung impedance during suctioning were less for CS than for OS (mean difference, − 905 impedance units; 95% confidence interval [CI], − 1234 to –587; P < .001). However, at all points postsuctioning, EELV recovered more slowly after CS than after OS. There were no statistically significant differences in the other respiratory parameters.
Closed suctioning minimized lung volume loss during suctioning but, counterintuitively, resulted in slower recovery of EELV postsuction compared with OS. Therefore, the use of CS cannot be assumed to be protective of lung volumes postsuctioning. Consideration should be given to restoring EELV after either suction method via a recruitment maneuver.
Endotracheal suctioning of the adult intubated patient-What is the evidence?
2009, Intensive and Critical Care Nursing
Intubated patients may be unable to adequately cough up secretions. Endotracheal suctioning is therefore important in order to reduce the risk of consolidation and atelectasis that may lead to inadequate ventilation. The suction procedure is associated with complications and risks including bleeding, infection, atelectasis, hypoxemia, cardiovascular instability, elevated intracranial pressure, and may also cause lesions in the tracheal mucosa. The aim of this article was to review the available literature regarding endotracheal suctioning of adult intubated intensive care patients and to provide evidence-based recommendations The major recommendations are suctioning only when necessary, using a suction catheter occluding less than half the lumen of the endotracheal tube, using the lowest possible suction pressure, inserting the catheter no further than carina, suctioning no longer than 15 s, performing continuous rather than intermittent suctioning, avoiding saline lavage, providing hyperoxygenation before and after the suction procedure, providing hyperinflation combined with hyperoxygenation on a non-routine basis, always using aseptic technique, and using either closed or open suction systems.
An in vitro evaluation of the effectiveness of endotracheal suction catheters
2005, Chest
Citation Excerpt :
Suctioning was accomplished by pulling the catheter through the ETT over 10 s at a pressure of 100 mm Hg, generated by using a portable suction vacuum (Easy-Vac PM 60; Precision Medical Devices; Northampton, PA). The suction time and pressure were based on published guidelines for endotracheal suctioning on adults with artificial airways.12,16,17 Effectiveness was measured by dividing the mass of simulant collected during the elapsed time into the original mass of simulant injected into the ETT.
Introduction: Tracheal suction catheters (TSCs) are used to clear mucus from an endotracheal tube (ETT). The clearance rate is critical because airway mucus stasis leads to obstruction, but prolonged catheter suctioning can lead to hypoxemia. The rate of mucus clearance from an ETT is thought to be influenced by the properties of the mucus, the pressure used to suction the mucus, and the diameter of the catheter. In this study, different adult TSCs were evaluated for their ability to suction mucus simulants that had properties similar to airway mucus.
Methods: Six different 14F TSC designs were evaluated. All catheters had the same end hole size, but the two side holes were sized at 3 mm, 4 mm, or 5 mm. A coagulant (Polyox Water Soluble Resin Coagulant NF; Dow Chemical Company; Cary, NC) was mixed with water at concentrations of 0.5%, 1.5%, and 3.0% to simulate mucus or sputum. Suction effectiveness was evaluated by the mass percentage of the coagulant suctioned over 10 s at 100 mm Hg from an 8.0 ETT.
Measurements and results: The 1.5% and 3.0% simulants had properties comparable to human airway mucus and sputum. Suction effectiveness was less with the 3.0% coagulant simulant compared with the 1.5% and 0.5% simulants. Suction effectiveness was greater (p < 0.01) with TSCs that had nonparallel holes and a side hole diameter of 5 mm when tested with the 1.5% and 3.0% simulants. However, no best catheter could be identified among TSCs when tested with the more liquid-like 0.5% simulant.
Conclusions: Greater TSC side hole diameter and nonparallel positioning was important for suctioning mucus simulants that are similar to mucus or sputum. The distance between side holes, end hole size, suction force, and duration of suctioning were not tested but could also have an effect on TSC performance.
Functional residual capacity changes after different endotracheal suctioning methods
2008, Anesthesia and Analgesia
Our primary objective was to investigate the effects of three different endotracheal suctioning procedures on functional residual capacity (FRC).
Using a crossover design, postoperative cardiac surgery patients (n = 20) received three different suctioning methods in randomized order: closed suctioning during pressure-controlled ventilation, closed suctioning during volume-controlled ventilation, and open suctioning. FRC was measured before and 20 min after the intervention.
FRC is reduced in postcardiac surgery patients after suctioning, regardless of which method is used. Certain patients may have very pronounced changes of FRC. Routine FRC measurements could complement respiratory monitoring to optimize respiratory therapy.
Effects of combined tracheal suctioning and expiratory pause: A crossover randomized clinical trial
2019, Indian Journal of Critical Care Medicine

View all citing articles on Scopus

: Financial support was provided by the Swedish Heart-Lung Fund, local funding at Uppsala University, and Datex-Ohmeda.

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Chest

Laboratory and Animal InvestigationsSide Effects of Endotracheal Suction in Pressure- and Volume-Controlled Ventilation

Study objectives

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

Section snippets

Materials and Methods

Effect of Suction During PCV and VCV Using a 14F OSS

Discussion

Preoxygenation for tracheal suctioning in intubated, ventilated newborn infants

Cochrane Database Syst Rev

Constant-flow insufflation prevents arterial oxygen desaturation during endotracheal suctioning

Am Rev Respir Dis

Closed versus open suctioning techniques

Minerva Anestesiol

Airway management

Artificial airways

Laboratory and Animal Investigations
Side Effects of Endotracheal Suction in Pressure- and Volume-Controlled Ventilation