RESUMEN
BACKGROUND: Endotracheal suctioning is required for mechanically ventilated patients to maintain a patent airway. Studies show that open endotracheal suctioning affects respiratory mechanics and gas exchange. The aim of this study was to compare the effectiveness of hyperoxygenation with FIO2 + 0.20 above baseline and hyperoxygenation with FIO2 1.0 in preventing hypoxemia, and to determine the impact of open endotracheal suctioning on the pulmonary ventilation of critical subjects receiving mechanical ventilatory support. METHODS: This prospective randomized crossover study was conducted in the ICU. Sixty-eight mechanically ventilated subjects with FIO2 ≤ 0.6 and requiring endotracheal suctioning were included in this study. Open endotracheal suctioning was performed using 2 different intervention sequences: hyperoxygenation of 0.20 above baseline FIO2 (FIO2 + 0.20) and 1.0 hyperoxygenation (FIO2 1.0). Oxygenation was assessed via oxygen saturation as measured by pulse oximetry (SpO2 ), and changes in lung ventilation were measured via alveolar gas volume (VÌA), alveolar minute volume (VÌA min), carbon dioxide (CO2) production (VÌCO2 ), mixed exhaled partial pressure of CO2 (PÌECO2 ), exhaled tidal CO2 volume (VTCO2), end-tidal CO2 (PETCO2 ), anatomical dead space to tidal volume ratio (VD/VT), and anatomical dead space volume of each breath (VD) using volumetric capnography, and breathing frequency (f), heart rate, and mean arterial pressure using a multiparameter monitor. RESULTS: SpO2 levels were significantly higher within interventions (FIO2 + 0.20 and 1.0) 1 min before and after suction. Also, there was a significant increase in PETCO2 , PÌECO2 , heart rate, and mean arterial pressure immediately after the procedure compared with baseline, and in VTCO2, only for FIO2 + 0.20. Baseline values were not found to be significantly different between the groups in case of any dependent variable. CONCLUSIONS: In mechanically ventilated adult subjects, hyperoxygenation with FIO2 + 0.20 above baseline prevents hypoxemia. Also, transient changes in pulmonary ventilation with open circuit suctioning were confirmed by volumetric capnography analysis. (Trial registration: ClinicalTrials.gov NCT02440919).
Asunto(s)
Dióxido de Carbono/metabolismo , Hipoxia/prevención & control , Oxígeno/administración & dosificación , Intercambio Gaseoso Pulmonar , Respiración Artificial , Anciano , Anciano de 80 o más Años , Presión Arterial , Capnografía , Dióxido de Carbono/análisis , Estudios Cruzados , Femenino , Frecuencia Cardíaca , Humanos , Intubación Intratraqueal , Masculino , Persona de Mediana Edad , Oximetría , Oxígeno/sangre , Estudios Prospectivos , Ventilación Pulmonar , Espacio Muerto Respiratorio/fisiología , Frecuencia Respiratoria , Método Simple Ciego , Succión , Volumen de Ventilación Pulmonar , TráqueaRESUMEN
BACKGROUND: Maintaining endotracheal tube patency is critical for neonates receiving mechanical ventilation. Endotracheal tube suctioning removes accumulated secretions preventing potential adverse events, however is also potentially hazardous to the patient. OBJECTIVE: To compare respiratory rate, arterial blood oxygen saturation, heart rate and pain in newborns undergoing endotracheal tube suctioning with closed (CS) and open (OS) systems. METHODS: Randomized crossover trial with 13 newborns from two Brazilian hospitals. The respiratory rate, arterial blood oxygen saturation, heart rate and pain (Premature Infant Pain Profile) were analysed: immediately before (T1), during (T2), immediately after (T3), 10 min after (T4) and 30 min (T5) after endotracheal suctioning. RESULTS: The majority (11/85·0%) of the newborns were premature and 45% weighed less than 1000 g. No statistically significant difference was identified according to the use of CS or OS to all the parameters investigated. The main results demonstrated that in T2 arterial blood oxygen saturation was higher with CS (CS 93·0%; OS 89 · 0%; p = 0·561). In T3 there was an increase in respiratory rate average only with the use of OS (T1 50·0; T3 56·0). The pain score in T2 and heart rate in T3 were higher with OS without significant differences (p = 0·114; p = 0·479, respectively). CONCLUSION: There was no significant difference in the studied clinical parameters or presence and intensity of pain according to the two investigated techniques of endotracheal tube suctioning. RELEVANCE TO CLINICAL PRACTICE: This research can provide support for clinical practice regarding endotracheal tube suctioning of newborns describing that the use of closed systems was similar to the open system regarding pain presence and intensity, as well as, in the clinical effects analysed, in accordance with other studies produced in this field.
Asunto(s)
Intubación Intratraqueal/métodos , Oxígeno/sangre , Dimensión del Dolor , Respiración Artificial/métodos , Succión/métodos , Análisis de los Gases de la Sangre , Brasil , Estudios Cruzados , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Recién Nacido , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Intubación Intratraqueal/efectos adversos , Masculino , Oximetría/métodos , Consumo de Oxígeno/fisiología , Respiración Artificial/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: During invasive mechanical ventilation, secretions accumulate in the subglottic space; consequently, there is a risk of aspiration of these secretions into the airway during cuff deflation and extubation. To minimize this risk, 2 extubation methods are used. The first consists of introducing a suction catheter into the endotracheal tube (ETT) and the trachea. After initiating suctioning, the cuff is deflated and the ETT is removed together with the suction catheter. The second technique involves applying positive pressure to the ETT using a resuscitation bag. Once the manual breath is delivered, the ETT cuff is deflated and the ETT is removed without suction. The aim of this laboratory study is to determine the existence and magnitude of differences in leak volume during cuff deflation and extubation using various combinations of positive pressure with or without endotracheal suctioning. METHODS: An ETT connected to a ventilator was placed in a model trachea. Colored water was instilled in the space above the cuff. To measure the leak volume, a collection chamber was attached to the distal end of the model. Nine procedures were defined, based on the delivery of different positive pressure levels with or without endotracheal suctioning during extubation. The volume of leakage, in milliliters, was the unit of analysis. Procedures yielding values lower than 1 mL were assessed by the Friedman test, and a P value of less than .05 was considered significant. Post hoc comparisons were performed with a Wilcoxon test, followed by a Bonferroni correction. RESULTS: The application of CPAP 15, pressure support ventilation (PSV)15/10, and PSV 20/5 produced 0.4, 0.2, and 0.1 mL of leak volume, respectively. Statistically significant differences were found between CPAP 15 and PSV 15/10 (P = .003) and between CPAP 15 and PSV 20/5 (P = .01), but not between PSV 15/10 and PSV 20/5 (P = .30). The addition of suctioning increased leak volume, with statistically significant differences between CPAP 15 and CPAP 15 + endotracheal suctioning (P = .001) and between PSV 15/10 and PSV 15/10 + endotracheal suctioning (P = .001). CONCLUSIONS: Endotracheal suctioning during cuff deflation and extubation produced greater leakage. Application of CPAP 15, PSV 15/10, and PSV 20/5 resulted in the lowest leak values, with the best results being obtained with the use of PSV 15/10 and PSV 20/5.