Chest
Volume 125, Issue 3, March 2004, Pages 1077-1080
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Laboratory and Animal Investigations
Side Effects of Endotracheal Suction in Pressure- and Volume-Controlled Ventilation

https://doi.org/10.1378/chest.125.3.1077Get 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 (0)

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

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