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Joo DH, Park HC, Kim JH, Yang SH, Kim TH, Kim HJ, Song MJ, Lim SY, Kim SA, Bae HW, Ahn YH, Yoon SM, Park J, Lee HY, Lee J, Lee SM, Lee JC, Cho YJ. Clinical Efficacy and Safety of an Automatic Closed-Suction System in Mechanically Ventilated Patients with Pneumonia: A Multicenter, Prospective, Randomized, Non-Inferiority, Investigator-Initiated Trial. Diagnostics (Basel) 2024; 14:1068. [PMID: 38893595 PMCID: PMC11172224 DOI: 10.3390/diagnostics14111068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Endotracheal suctioning is an essential but labor-intensive procedure, with the risk of serious complications. A brand new automatic closed-suction device was developed to alleviate the workload of healthcare providers and minimize those complications. We evaluated the clinical efficacy and safety of the automatic suction system in mechanically ventilated patients with pneumonia. In this multicenter, randomized, non-inferiority, investigator-initiated trial, mechanically ventilated patients with pneumonia were randomized to the automatic device (intervention) or conventional manual suctioning (control). The primary efficacy outcome was the change in the modified clinical pulmonary infection score (CPIS) in 3 days. Secondary outcomes were the frequency of additional suctioning and the amount of secretion. Safety outcomes included adverse events or complications. A total of 54 participants, less than the pre-determined number of 102, were enrolled. There was no significant difference in the change in the CPIS over 72 h (-0.13 ± 1.58 in the intervention group, -0.58 ± 1.18 in the control group, p = 0.866), but the non-inferiority margin was not satisfied. There were no significant differences in the secondary outcomes and safety outcomes, with a tendency for more patients with improved tracheal mucosal injury in the intervention group. The novel automatic closed-suction system showed comparable efficacy and safety compared with conventional manual suctioning in mechanically ventilated patients with pneumonia.
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Affiliation(s)
- Dong-Hyun Joo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Hyo Chan Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Joon Han Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Seo Hee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Tae Hun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Hyung-Jun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Myung Jin Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Sung Yoon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Sung A Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
| | - Hee Won Bae
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
| | - Yoon Hae Ahn
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (Y.H.A.); (S.M.Y.); (H.Y.L.)
| | - Si Mong Yoon
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (Y.H.A.); (S.M.Y.); (H.Y.L.)
| | - Jimyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
| | - Hong Yeul Lee
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (Y.H.A.); (S.M.Y.); (H.Y.L.)
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (Y.H.A.); (S.M.Y.); (H.Y.L.)
| | - Jung Chan Lee
- Department of Biomedical Engineering, Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
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de Almeida CM, Pollo CF, Meneguin S. Nursing Interventions for Patients with Intracranial Hypertension: Integrative Literature Review. AQUICHAN 2019. [DOI: 10.5294/aqui.2019.19.4.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: the study sought to identify, in national and international publications, the principal Nursing interventions aimed at patients with intracranial hypertension. Materials and Method: integrative literature review with search in LILACS, PubMed, Scopus, Web of Science, Cinahal, and Google Scholar databases, from 2013 to 2018. Results: the sample was comprised of seven articles fulfilling the inclusion criteria. Two thematic categories were established for the Nursing interventions aimed at patients with intracranial hypertension: cognitive skills and clinical reasoning, necessary to control neuro-physiological parameters and prevent intracranial hypertension, and evidence-based practices to improve care for neuro-critical patients. Conclusions: intracranial hypertension is an event of great clinical impact, whose complications can be minimized and control through specific Nursing interventions that encompass control of neuro-physiological and hemodynamic parameters and prevention of increased intracranial pressure related with the performance of procedures by the Nursing staff.
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Ebrahimian A, Tourdeh M, Paknazar F, Davari H. The Effect of the Open and Closed System Suctions on Pain Severity and Physiological Indicators in Mechanically Ventilated Patients with Traumatic Brain Injury: A Randomised Controlled Trial. Turk J Anaesthesiol Reanim 2019; 48:202-207. [PMID: 32551447 PMCID: PMC7279868 DOI: 10.5152/tjar.2019.03342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/13/2019] [Indexed: 11/22/2022] Open
Abstract
Objective Tracheal suctioning can cause pain and physiological indicator variations in patients with traumatic brain injury (TBI). The aim of the present study was to compare pain severity and physiological indicator variations during the closed tracheal suction system (CTSS) and open tracheal suction system (OTSS) in patients with TBI. Methods This study was a clinical trial. Samples included all ventilated patients with TBI. The patients were randomly divided into the OTSS and CTSS groups. In both groups, the Critical Care Pain Observation Tool (CPOT) and physiological indicators were recorded by three nurses prior to suctioning, the end of suctioning and 5 min after suction completion. Data were analysed using the independent t-test and repeated measurement tests. Results A total of 112 patients participated in the present study. Before the interventions, the mean value of the Glasgow Coma Scale was 6.45±1.13, blood pressure 128.33±20.54, saturated oxygen in arterial blood (SpO2) 96.74±2.76, respiratory rate (RR) 15.06±3.98, end-tidal CO2 (EtCO2) 36.2±21.98, heart rate 82.18±42.33 and CPOT-based pain 0.43±0.94 in the patients. Independent t-test was used to compare CTSS and OTSS, suggesting significant differences with respect to the mean values of SpO2, RR and EtCO2 immediately after suctioning. This test showed significant differences between the two groups with respect to pain intensity at all three points of measurement. The two groups were also found to be significantly different with respect to RR measured 5 min after suctioning (p<0.05). Conclusion Compared to OTSS, CTSS can cause higher reductions in pain levels during and after suctioning in patients with head traumas and can also cause higher improvements in physiological indicators, such as RR, O2 saturation and EtCO2.
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Affiliation(s)
- Abbasali Ebrahimian
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Maedeh Tourdeh
- School of Paramedicine, Qom University of Medical Sciences, Qom, Iran
| | - Fatemeh Paknazar
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Hossein Davari
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
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Effects of Closed Endotracheal Suctioning on Systemic and Cerebral Oxygenation and Hemodynamics in Children. Pediatr Crit Care Med 2018; 19:e23-e30. [PMID: 29189639 DOI: 10.1097/pcc.0000000000001377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the effects of closed endotracheal tube suctioning on systemic oxygen saturation, cerebral regional oxygen saturation, and somatic regional (renal) oxygen saturation and hemodynamic variables in children. DESIGN Prospective observational. SETTING A tertiary care PICU. SUBJECTS Children aged 0-18 years, requiring invasive mechanical ventilation and with an arterial line. INTERVENTIONS Closed endotracheal suction. MEASUREMENTS AND MAIN RESULTS The study included 19 sedated and intubated children, 0-18 years old. They were enrolled in an ongoing prospective observational study. We used near-infrared spectroscopy for cerebral regional oxygen saturation and somatic regional (renal) oxygen saturation. The timing of each closed endotracheal tube suctioning event was accurately identified from video recordings. We extracted systemic oxygen saturation, cerebral regional oxygen saturation, somatic regional (renal) oxygen saturation, heart rate, and systolic blood pressure and diastolic blood pressure for 5 minutes before and 5 minutes after each event and used these data for analysis. One-minute average values of these variables were used for repeated-measures analysis. We analyzed 287 endotracheal tube suctioning episodes in 19 children. Saline was instilled into the endotracheal tube during 61 episodes. The mean heart rate (107.0 ± 18.7 vs 110.2 ± 10.4; p < 0.05), mean arterial blood pressure (81.5 ± 16.1 vs 83.0 ± 15.6 mm Hg; p < 0.05), and the mean cerebral regional oxygen saturation (64.8 ± 8.3 vs 65.8 ± 8.3; p < 0.05) were increased after suctioning. The mean systemic oxygen saturation (96.9 ± 2.7 vs 96.7 ± 2.7; p = 0.013) was decreased, whereas the mean somatic regional (renal) oxygen saturation was not significantly different after endotracheal tube suctioning. Repeated-measures analysis revealed transient increases in heart rate, respiratory rate, systolic blood pressure, and diastolic blood pressure; a sustained increase in cerebral regional oxygen saturation; and transient decreases in systemic oxygen saturation and somatic regional (renal) oxygen saturation. Saline instillation did not affect oxygenation or hemodynamic variables. CONCLUSIONS Closed endotracheal tube suctioning in sedated children is associated with transient but clinically insignificant changes in heart rate, blood pressure, cerebral regional oxygen saturation, systemic oxygen saturation, and somatic regional (renal) oxygen saturation. Saline instillation during endotracheal tube suctioning had no adverse effects on systemic or cerebral oxygenation.
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Open and Closed Endotracheal Suctioning and Arterial Blood Gas Values: A Single-Blind Crossover Randomized Clinical Trial. Crit Care Res Pract 2015; 2015:470842. [PMID: 26425366 PMCID: PMC4573878 DOI: 10.1155/2015/470842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/26/2015] [Indexed: 02/02/2023] Open
Abstract
Aim. This study was aimed at comparing the effects of the open and closed suctioning techniques on the arterial blood gas values in patients undergoing open-heart surgery. Methods. In a clinical trial, we recruited 42 patients after open-heart surgery in an educational hospital. Each patient randomly underwent both open and closed suctioning. ABGs, PaO2, SaO2, PaCO2, were analyzed before and one, five, and fifteen minutes after each suctioning episode. Results. At first the pressure of oxygen in arterial blood increased; however, this increase in the open technique was greater than that of the closed system (P < 0.001). The pressure of oxygen decreased five and fifteen minutes after both suctioning techniques (P < 0.05). The trends of carbon dioxide variations after the open and closed techniques were upward and downward, respectively. Moreover, the decrease in the level of oxygen saturation five and fifteen minutes after the open suctioning was greater than that of the closed suctioning technique (P < 0.05). Conclusion. Arterial blood gas disturbances in the closed suctioning technique were less than those of the open technique. Therefore, to eliminate the unwanted effects of endotracheal suctioning on the arterial blood gases, the closed suctioning technique is recommended.
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Olson DM, Rogers MS, Stutzman SE. Electronic Medical Record Validation: Exploring the Reliability of Intracranial Pressure Data Abstracted From the Electronic Medical Record–Pilot. J Nurs Meas 2015; 23:532-540. [DOI: 10.1891/1061-3749.23.3.532] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: Intracranial pressure (ICP) monitoring is crucial to decision making for neurologically injured patients, yet measurement of ICP varies greatly among practitioners. Methods: Unblinded, nonrandomized, observational pilot study comparing ICP values collected using pen and paper (P&P), electronic medical record (EMR), and video data with continuous data acquisition (CDA) technology. Results: ICP values did not significantly differ between EMR and P&P records, despite an average of 16 minutes difference in reporting times. ICP values varied significantly when comparing CDA data to EMR or paper. Conclusion: The results of this pilot study put in to question the validity of ICP values that are recorded in the medical record, which has implications for patient care and research.
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Abbasinia M, Irajpour A, Babaii A, Shamali M, Vahdatnezhad J. Comparison the effects of shallow and deep endotracheal tube suctioning on respiratory rate, arterial blood oxygen saturation and number of suctioning in patients hospitalized in the intensive care unit: a randomized controlled trial. J Caring Sci 2014; 3:157-64. [PMID: 25276759 DOI: 10.5681/jcs.2014.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 07/11/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Endotracheal tube suctioning is essential for improve oxygenation in the patients undergoing mechanical ventilation. There are two types of shallow and deep endotracheal tube suctioning. This study aimed to evaluate the effect of shallow and deep suctioning methods on respiratory rate (RR), arterial blood oxygen saturation (SpO2) and number of suctioning in patients hospitalized in the intensive care units of Al-Zahra Hospital, Isfahan, Iran. METHODS In this randomized controlled trial, 74 patients who hospitalized in the intensive care units of Isfahan Al-Zahra Hospital were randomly allocated to the shallow and deep suctioning groups. RR and SpO2 were measured immediately before, immediately after, 1 and 3 minute after each suctioning. Number of suctioning was also noted in each groups. Data were analyzed using repeated measures analysis of variance (RMANOVA), chi-square and independent t-tests. RESULTS RR was significantly increased and SpO2 was significantly decreased after each suctioning in the both groups. However, these changes were not significant between the two groups. The numbers of suctioning was significantly higher in the shallow suctioning group than in the deep suctioning group. Conclusion : Shallow and deep suctioning had a similar effect on RR and SpO2. However, shallow suctioning caused further manipulation of patient's trachea than deep suctioning method. Therefore, it seems that deep endotracheal tube suctioning method can be used to clean the airway with lesser manipulation of the trachea.
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Affiliation(s)
- Mohammad Abbasinia
- Departemant of Nursing, Faculty of Nursing & Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Alireza Irajpour
- Departemant of Nursing, Faculty of Nursing & Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atye Babaii
- Departemant of Nursing, Faculty of Nursing & Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Mehdi Shamali
- Departemant of Nursing, Faculty of Nursing & Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jahanbakhsh Vahdatnezhad
- Departemant of Nursing, Faculty of Nursing & Midwifery, Yasuj University of Medical Sciences, Yasuj, Iran
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Özden D, Görgülü RS. Effects of open and closed suction systems on the haemodynamic parameters in cardiac surgery patients. Nurs Crit Care 2014; 20:118-25. [PMID: 24991700 DOI: 10.1111/nicc.12094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 02/26/2014] [Accepted: 03/03/2014] [Indexed: 11/27/2022]
Abstract
AIMS This study was carried out to determine the effects of open and closed suction systems on haemodynamic parameters of the patients who underwent open heart surgery. BACKGROUND Nurses should work meticulously and carefully as many complications may develop if the method used to perform suctioning is not appropriate. DESIGN The quasi-experimental study design was used. METHOD The study sample comprised 120 patients who underwent open heart surgery in the cardiovascular surgery intensive care unit of a state hospital in Turkey. Haemodynamic parameters were determined just before, right after, at the 5th and 15th minute after suctioning. The data were evaluated with the One-Way Analysis of Variance (ANOVA) for Repeated Measures, independent t-test and Bonferroni's test for further analysis (post hoc). RESULTS The difference between heart rate (HR) and mean blood pressure, mean PaO2 and PaCO2 , SaO2 and pH values measured before, right after and at the 5th and 15th minute after suctioning was found to be significant in patients who underwent the open suctioning procedure. It was determined that the difference between mean PaO2 values was not significant and that SaO2 versus SpO2 values increased in patients who underwent the closed suctioning procedure. When the open and closed suction systems were compared, statistically significant difference was determined in terms of MAP, SpO2 . CONCLUSION It was determined that HR, arterial blood pressure and arterial blood gases of the patients who underwent open heart surgery were negatively affected by the open suction system but did not increase significantly as soon as suctioning was over during the closed suctioning procedure. The data obtained indicate that closed system suctioning, compared with open system suctioning, can be used safely on this patient group. RELEVANCE TO CLINICAL PRACTICE The closed suction system is recommended since it contributes to the enhancement of patient safety and the quality of nursing care.
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Affiliation(s)
- Dilek Özden
- Dokuz Eylül University, Faculty of Nursing, İzmir, Turkey
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