Chest
Volume 83, Issue 4, April 1983, Pages 621-627
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Journal Article
Prevention of Suctioning-Related Arterial Oxygen Desaturation: Comparison of Off-Ventilator and On-Ventilator Suctioning

https://doi.org/10.1378/chest.83.4.621Get rights and content

The purpose of this study was to determine the frequency and severity of arterial oxygen desaturation during and after endotracheal suctioning in a group of ventilator-dependent patients with acute respiratory failure (the majority of whom had underlying obstructive lung disease) and to evaluate the efficacy of several maneuvers designed to minimize desaturation. The adaptor method presented obviates both removal from and reconnection to the ventilator during suctioning, as well as the need to alter ventilator settings. It is concluded that on-ventilator adaptor suctioning is a simple and effective measure for minimizing suctioning-related arterial oxygen desaturation.

Section snippets

Patient Population

The study population consisted of acutely-ill intubated patients in the Medical Intensive Care Unit of the Long Beach VA Medical Center who required positive pressure ventilation and had copious secretions requiring frequent suctioning. Most patients had underlying obstructive lung disease and were admitted for acute decompensation for a variety of reasons, including bronchitis, pneumonia, and acute episodes of bronchospasm (Table 1).

Methods

All patients were ventilated with Bennett MA-1 ventilators,

Phase 1

The mean baseline SaO2 for the group with each suctioning technique was very similar and did not differ significantly (Table 2). When patients were suctioned off the ventilator without extra breaths (control suctioning), a significant drop occurred in the mean SaO2 from 94.3 ± 2.6 percent before to 90.8 ± 3.25 percent after suctioning (p<0.001). In six patients (50 percent), a decrease of 3 percent or more was seen, while in four patients (33 percent), the decrease was 4 percent or greater;

DISCUSSION

This study shows that significant suctioning-associated arterial oxygen desaturation occurs in medical patients with acute respiratory failure superimposed on chronic obstructive lung disease. This is in agreement with numerous other studies which have examined populations of surgical patients (most of whom had no pre-existing lung disease),8, 9, 10, 12, 13, 14, 15 pediatric patients,16, 17 laboratory animals,18 and patients with respiratory failure.19 Changes in saturation (calculated from PaO2

ACKNOWLEDGMENT

The authors thank Mrs. Barbara Ikeda for her expert preparation of the manuscript.

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