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Research ArticleOriginal Research

Open and Closed Endotracheal Suction Systems Divergently Affect Pulmonary Function in Mechanically Ventilated Subjects

Rodrigo Daminello Raimundo, Monica Akemi Sato, Talita Dias da Silva, Luiz Carlos de Abreu, Vitor Engrácia Valenti, Daniel William Riggs and Alex Perrow Carll
Respiratory Care May 2021, 66 (5) 785-792; DOI: https://doi.org/10.4187/respcare.08511
Rodrigo Daminello Raimundo
Laboratório de delineamento de estudos e escrita científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil.
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Monica Akemi Sato
Laboratório de delineamento de estudos e escrita científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil.
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Talita Dias da Silva
Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo (UFES), Vitória, Espírito Santo, Brazil. Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts.
Departamento de Cardiologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.
Faculdade de Medicina, Universidade Cidade de São Paulo, São Paulo, Brazil.
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  • For correspondence: [email protected]
Luiz Carlos de Abreu
Laboratório de delineamento de estudos e escrita científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil.
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Vitor Engrácia Valenti
Departamento de estudos sobre o Sistema nervoso autonômico, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, São Paulo, Brazil.
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Daniel William Riggs
Diabetes and Obesity Center, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky.
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Alex Perrow Carll
Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo (UFES), Vitória, Espírito Santo, Brazil. Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts.
Diabetes and Obesity Center, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky.
Department of Physiology, School of Medicine, University of Louisville, Louisville, Kentucky.
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Abstract

BACKGROUND: In mechanically ventilated subjects, intra-tracheal secretions can be aspirated with either open suction systems (OSS) or closed suction systems (CSS). In contrast to CSS, conventional OSS require temporarily disconnecting the patient from the ventilator, which briefly diminishes PEEP and oxygen supply. On the other hand, CSS are more expensive and less effective at aspirating secretions. Thus, it was hypothesized that the 2 procedures differentially affect pulmonary and cardiovascular parameters after suction.

METHODS: Subjects in the ICU (N = 66) were quasi-randomized for initial treatment with OSS or CSS in a crossover design. To compare the potential for these suction systems to compromise cardiorespiratory stability, changes in cardiopulmonary physiology were assessed from before to just after use of each suction system (three 10-s aspirations).

RESULTS: For most pulmonary and cardiovascular parameters (ie, peak inspiratory pressure, airway resistance, pressure plateau, heart rate, and arterial pressures), the effects of aspiration inversely correlated with baseline values for that parameter, with a similar regression slope between suction systems. However, when controlling for baseline values, OSS caused significantly greater increases in airway resistance and peak inspiratory pressure (P < .001 and < .01 vs CSS, respectively).

CONCLUSIONS: Elevated airway resistance prior to endotracheal suction may justify use of a CSS and contraindicate a conventional OSS in mechanically ventilated subjects. Adoption of this approach into clinical guidelines may prevent suction-induced pulmonary injury in subjects, especially for those with underlying diseases involving increased airway resistance or increased alveolar pressure. (ClinicalTrials.gov registration: NCT03256214.)

  • endotracheal aspiration
  • airway resistance
  • pulmonary compliance
  • mechanical ventilation
  • pulmonary pressure
  • lung

Footnotes

  • Correspondence: Talita Dias da Silva PhD, Harvard School of Public Health, Department of Environmental Health, 677 Huntington Ave, Boston, MA 02115. E-mail: talita.dias{at}unifesp.br
  • Drs Riamundo and Sato are co-first authors.

  • The authors have disclosed no conflicts of interest.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (5)
Respiratory Care
Vol. 66, Issue 5
1 May 2021
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Open and Closed Endotracheal Suction Systems Divergently Affect Pulmonary Function in Mechanically Ventilated Subjects
Rodrigo Daminello Raimundo, Monica Akemi Sato, Talita Dias da Silva, Luiz Carlos de Abreu, Vitor Engrácia Valenti, Daniel William Riggs, Alex Perrow Carll
Respiratory Care May 2021, 66 (5) 785-792; DOI: 10.4187/respcare.08511

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Open and Closed Endotracheal Suction Systems Divergently Affect Pulmonary Function in Mechanically Ventilated Subjects
Rodrigo Daminello Raimundo, Monica Akemi Sato, Talita Dias da Silva, Luiz Carlos de Abreu, Vitor Engrácia Valenti, Daniel William Riggs, Alex Perrow Carll
Respiratory Care May 2021, 66 (5) 785-792; DOI: 10.4187/respcare.08511
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Keywords

  • endotracheal aspiration
  • airway resistance
  • pulmonary compliance
  • mechanical ventilation
  • pulmonary pressure
  • lung

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