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Endotracheal Suction a Reopened Problem
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
2005 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

During mechanical ventilation, patients are connected to the ventilator by an endotracheal tube. The tube needs to be cleaned from mucus by suction, which can cause negative effects such as lung collapse, hypoxemia and desaturation. These can be avoided by preoxygenation, change of ventilator settings, use of closed suction systems and recruitment manoeuvres. The aim of the study was to investigate the effects of endotracheal suction during different ventilator settings and by different suction methods. A method to reverse side effects was investigated.

In anaesthetized pigs, the effect of suction during volume and pressure-controlled ventilation was investigated, and the effect of different suction systems and catheter sizes were compared. Suction efficacy was investigated in a bench study. The effect of recruitment manoeuvre added after suction, i.e. post-suction recruitment manoeuvre was evaluated.

Endotracheal suction causes lung volume loss leading to impaired gas exchange, an effect that is more severe in pressure-controlled ventilation than in volume-controlled ventilation. When 14 French suction catheters were used more side effects were found compared to 12 French catheters, but no difference was found between open and closed suction system in pressure-controlled ventilation. Open suction system was more effective to remove mucus compared to closed system. Post-suction recruitment manoeuvre restored the side effects after the first recruitment when it was applied directly after suction.

In conclusion, open endotracheal suction causes impairment in gas exchange and lung mechanics, and more so in pressure-controlled than in volume-controlled mode. These changes can be minimized if smaller suction catheters are used. A post-suction recruitment manoeuvre applied directly after suction restores lung function. It is obvious that the recruitment manoeuvre should be added directly after suction, because if the manoeuvre is delayed and the lung is collapsed and left collapsed, it will be more difficult to recruit the lung.

sted, utgiver, år, opplag, sider
Uppsala: Acta Universitatis Upsaliensis , 2005. , s. 55
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 11
Emneord [en]
Physiology, Mechanical, ventilation, endotracheal, suction, lung, volume, loss, gas, exchange
Emneord [sv]
Fysiologi
HSV kategori
Identifikatorer
URN: urn:nbn:se:uu:diva-4798ISBN: 91-554-6154-9 (tryckt)OAI: oai:DiVA.org:uu-4798DiVA, id: diva2:165803
Disputas
2005-03-18, B42, BMC, Ingång A4, Husargatan 3, Uppsala, 09:15
Opponent
Veileder
Tilgjengelig fra: 2005-02-25 Laget: 2005-02-25 Sist oppdatert: 2018-01-13bibliografisk kontrollert
Delarbeid
1. Side effects of endotracheal suction in pressure and volume controlled ventilation
Åpne denne publikasjonen i ny fane eller vindu >>Side effects of endotracheal suction in pressure and volume controlled ventilation
2004 (engelsk)Inngår i: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 125, nr 3, s. 1077-1080Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

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 PaO(2) by 26% (p < 0.001); PaCO(2) 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.

Emneord
Animals, Intubation; Intratracheal/*adverse effects, Lung Compliance, Pulmonary Gas Exchange, Respiration; Artificial/*methods, Suction/*adverse effects, Support; Non-U.S. Gov't, Swine, Tidal Volume
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-92641 (URN)10.1378/chest.125.3.1077 (DOI)15006972 (PubMedID)
Tilgjengelig fra: 2005-02-25 Laget: 2005-02-25 Sist oppdatert: 2018-01-13bibliografisk kontrollert
2. Negative tracheal pressure during suction differs between suction systems and catheter sizes
Åpne denne publikasjonen i ny fane eller vindu >>Negative tracheal pressure during suction differs between suction systems and catheter sizes
2005 (engelsk)Artikkel i tidsskrift (Fagfellevurdert) Published
sted, utgiver, år, opplag, sider
Uppsala: Institutionen för medicinsk cellbiologi, 2005
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-7236 (URN)
Tilgjengelig fra: 2007-10-24 Laget: 2007-10-24 Sist oppdatert: 2018-01-13
3. Effectiveness and side effects of closed and open suctioning: an experimental evaluation
Åpne denne publikasjonen i ny fane eller vindu >>Effectiveness and side effects of closed and open suctioning: an experimental evaluation
Vise andre…
2004 Inngår i: Intensive Care Medicine, Vol. 30, nr 8, s. 1630-7Artikkel i tidsskrift (Fagfellevurdert) Published
Identifikatorer
urn:nbn:se:uu:diva-92643 (URN)
Tilgjengelig fra: 2005-02-25 Laget: 2005-02-25bibliografisk kontrollert
4. Post-suction recruitment manoeuvre restores lung function in healthy, anaesthetized pigs
Åpne denne publikasjonen i ny fane eller vindu >>Post-suction recruitment manoeuvre restores lung function in healthy, anaesthetized pigs
2004 (engelsk)Inngår i: Anaesthesia and Intensive Care, ISSN 0310-057X, E-ISSN 1448-0271, Vol. 32, nr 3, s. 339-345Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Endotracheal suction can cause partial lung collapse and hypoxia and alter lung mechanics. We investigated the effects of adding a recruitment manoeuvre directly after endotracheal suction to restore lung volume in volume-controlled ventilation and pressure-controlled ventilation modes. Five anaesthetized pigs were investigated. The effects of endotracheal suction with or without a recruitment manoeuvre were compared in random order. In volume-controlled ventilation, compliance decreased after suction from 33 +/- 5 to 26 +/- 6 ml x cmH2O(-1) (P<0.05), and 30 minutes later it remained decreased at 25 +/- 6 ml x cmH2O(-1). Venous admixture increased after suction from 5 +/- 2 to 8 +/- 4% (P<0.05), but had recovered at 30 minutes. In pressure-controlled ventilation, compliance decreased after suction from 34 +/- 3 to 25 +/- 7 ml x cmH2O(-1) (P<0.05), and 30 minutes later it remained decreased at 25 +/- 7 ml x cmH2O(-1). Venous admixture increased after suction from 5 +/- 2 to 13 +/- 7% (P<0.05), and had not recovered after 30 minutes, 10 +/- 4%. When a recruitment manoeuvre was applied directly after suction, no negative side-effects were registered in volume-controlled ventilation or pressure-controlled ventilation. We conclude that the impairment of lung mechanics and gas exchange induced by endotracheal suction can be prevented by a simple post-suction recruitment manoeuvre. Further studies are needed to identify a suitable suction recruitment manoeuvre in patients with diseased lungs.

HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-92644 (URN)15264727 (PubMedID)
Tilgjengelig fra: 2005-02-25 Laget: 2005-02-25 Sist oppdatert: 2018-01-13bibliografisk kontrollert
5. The time frame for post-suction recruitment manoeuvre
Åpne denne publikasjonen i ny fane eller vindu >>The time frame for post-suction recruitment manoeuvre
Manuskript (Annet vitenskapelig)
Identifikatorer
urn:nbn:se:uu:diva-92645 (URN)
Tilgjengelig fra: 2005-02-25 Laget: 2005-02-25 Sist oppdatert: 2010-01-13bibliografisk kontrollert

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