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Research ArticleOriginal Contributions

The Impact of Closed Endotracheal Suctioning Systems on Mechanical Ventilator Performance

Ashraf El Masry, Purris F Williams, Daniel W Chipman, Joseph P Kratohvil and Robert M Kacmarek
Respiratory Care March 2005, 50 (3) 345-353;
Ashraf El Masry
Department of Anesthesia and Critical Care and the Department of Respiratory Care, Massachusetts General Hospital, and with Harvard Medical School
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Purris F Williams
Department of Respiratory Care, Massachusetts General Hospital
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Daniel W Chipman
Department of Respiratory Care, Massachusetts General Hospital
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Joseph P Kratohvil
Department of Respiratory Care, Massachusetts General Hospital
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Robert M Kacmarek
Department of Respiratory Care, Massachusetts General Hospital, and with Harvard Medical School, Boston, Massachusetts.
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Abstract

BACKGROUND: Closed endotracheal suctioning during mechanical ventilation is increasingly used, but its impact on ventilator function has not been fully studied.

METHODS: We evaluated the impact of closed suctioning with 11 critical-care ventilators, during assisted ventilation in pressure-support mode, pressure-assist/control mode, volume-assist/control mode, and during continuous positive airway pressure, with 2 suctioning pressures (−120 mm Hg and approximately −200 mm Hg), and with 2 tidal volumes (450 mL and 900 mL). We continuously measured airway pressure, flow at the airway, and pressure distal to the catheter tip, before, during, and after a single 15-second period of continuous suctioning.

RESULTS: No ventilator malfunctioned as a result of the closed suctioning. During suctioning, end-expiratory pressure markedly decreased in all modes, and peak flow increased in all modes except volume-assist/control (p < 0.001). Respiratory rate increased during suctioning in pressure- and volume-assist/control (p < 0.001) but not during pressure support or continuous positive airway pressure. Gas delivery was most altered during volume-assist/control with the smaller tidal volume (p < 0.05) and least altered during pressure-assist/control with the larger tidal volume.

CONCLUSION: There are large differences between the ventilators evaluated (p < 0.001). Closed suctioning does not cause mechanical ventilator malfunction. Upon removal of the suction catheter, these ventilators resumed their pre-suctioning-procedure gas delivery within 2 breaths, and, during all the tested modes, all the ventilators maintained gas delivery. However, closed suctioning can decrease end-expiratory pressure during suctioning.

  • airway suctioning
  • closed suctioning
  • mechanical ventilators
  • lung model

Footnotes

  • Correspondence: Robert M Kacmarek PhD RRT FAARC, Respiratory Care, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02114. E-mail: rkacmarek{at}partners.org.
  • Copyright © 2005 by Daedalus Enterprises Inc.
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Respiratory Care: 50 (3)
Respiratory Care
Vol. 50, Issue 3
1 Mar 2005
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The Impact of Closed Endotracheal Suctioning Systems on Mechanical Ventilator Performance
Ashraf El Masry, Purris F Williams, Daniel W Chipman, Joseph P Kratohvil, Robert M Kacmarek
Respiratory Care Mar 2005, 50 (3) 345-353;

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The Impact of Closed Endotracheal Suctioning Systems on Mechanical Ventilator Performance
Ashraf El Masry, Purris F Williams, Daniel W Chipman, Joseph P Kratohvil, Robert M Kacmarek
Respiratory Care Mar 2005, 50 (3) 345-353;
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  • airway suctioning
  • closed suctioning
  • mechanical ventilators
  • lung model

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