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Bülbül Maraş G, Eşer İ, Şenoğlu N, Özkalay Yılmaz N, Karaca Derici Y. Increasing suction pressure during endotracheal suctioning increases the volume of suctioned secretions, but not procedure-related complications: A comparative study in open system endotracheal suctioning. Intensive Crit Care Nurs 2020; 61:102928. [PMID: 32859482 DOI: 10.1016/j.iccn.2020.102928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the effect of three different suction pressures (80 mmHg, 150 mmHg, 250 mmHg) with the open system suction method in terms of the volume of secretions and complications development in intubated intensive care patients. RESEARCH METHODOLOGY/DESIGN This study was planned as a prospective, experimental, self-controlled design. The study sample included 47 patients. Data were collected using a data collection and patient follow-up form from patient records. SETTING Single adult intensive care unit in a university hospital. RESULTS Fifty five percent of the patients were male, 61.7% were older than 65 years and 38.32% had lung infection. The amount of suctioned secretions tended to increase significantly with increasing negative pressure and there was a significant difference between the pressures in terms of the median volume of suctioned secretions (p < 0.001). There was no significant difference between the suction pressures in terms of oxygen desaturation, hypertension rates (p > 0.05). Tachycardia, bradycardia, hypoxaemia, tracheal mucosal damage or mucosal bleeding were not observed during suctioning with three different suction pressures. CONCLUSION It may be assumed that 250 mmHg suction pressure, via compliance with open system suction method related procedures, is being more effective and equally safe for secretion cleaning in comparison to the 80 and 150 mmHg suction pressures.
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Affiliation(s)
- Gül Bülbül Maraş
- Elderly Care Program, Vocational School of Health Service, İzmir Demokrasi University, İzmir, Turkey.
| | - İsmet Eşer
- Department of Fundementals Nursing, Faculty of Nursing, Ege University, İzmir, Turkey
| | - Nimet Şenoğlu
- Department of Anesthesiology and Reanimation, University of Health Sciences, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Nisel Özkalay Yılmaz
- Clinical Microbiology and Infectious Diseases, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Yeşer Karaca Derici
- Clinical Microbiology and Infectious Diseases, Tepecik Training and Research Hospital, İzmir, Turkey
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Karmali S, Rose P. Tracheal tube size in adults undergoing elective surgery - a narrative review. Anaesthesia 2020; 75:1529-1539. [PMID: 32415788 DOI: 10.1111/anae.15041] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2020] [Indexed: 12/17/2022]
Abstract
Tracheal tubes are routinely used in adults undergoing elective surgery. The size of the tracheal tube, defined by its internal diameter, is often generically selected according to sex, with 7-7.5 mm and 8-8.5 mm tubes recommended in women and men, respectively. Tracheal diameter in adults is highly variable, being narrowest at the subglottis, and is affected by height and sex. The outer diameter of routinely used tracheal tubes may exceed these dimensions, traumatise the airway and increase the risk of postoperative sore throat and hoarseness. These complications disproportionately affect women and may be mitigated by using smaller tracheal tubes (6-6.5 mm). Patient safety concerns about using small tracheal tubes are based on critical care populations undergoing prolonged periods of tracheal intubation and not patients undergoing elective surgery. The internal diameter of the tube corresponds to its clinical utility. Tracheal tubes as small as 6.0 mm will accommodate routinely used intubation aids, suction devices and slim-line fibreoptic bronchoscopes. Positive pressure ventilation may be performed without increasing the risk of ventilator-induced lung injury or air trapping, even when high minute volumes are required. There is also no demonstrable increased risk of aspiration or cuff pressure damage when using smaller tracheal tubes. Small tracheal tubes may not be safe in all patients, such as those with high secretion loads and airflow limitation. A balanced view of risks and benefits should be taken appropriate to the clinical context, to select the smallest tracheal tube that permits safe peri-operative management.
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Affiliation(s)
- S Karmali
- Department of Anaesthesiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - P Rose
- Department of Anaesthesiology, Vancouver General Hospital, Vancouver, BC, Canada
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Turbil E, Terzi N, Schwebel C, Cour M, Argaud L, Guérin C. Does endo-tracheal tube clamping prevent air leaks and maintain positive end-expiratory pressure during the switching of a ventilator in a patient in an intensive care unit? A bench study. PLoS One 2020; 15:e0230147. [PMID: 32160252 PMCID: PMC7065807 DOI: 10.1371/journal.pone.0230147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/21/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives When patients with acute respiratory distress syndrome are moved out of an intensive care unit, the ventilator often requires changing. This procedure suppresses positive end expiratory pressure and promotes lung derecruitment. Clamping the endotracheal tube may prevent this from occurring. Whether or not such clamping maintains positive end-expiratory pressure has never been investigated. We designed a bench study to explore this further. How the study was done We used the Elysee 350 ventilator in ‘volume controlled’ mode with a positive end-expiratory pressure of 15 cmH2O, connected to an endotracheal tube with an 8 mm internal diameter inserted into a lung model with 40 ml/cmH2O compliance and 10 cmH2O/L/s resistance. We measured airway pressure and flow between the distal end of the endotracheal tube and the lung model. We tested a plastic, a metal, and an Extra Corporeal Membrane Oxygenation clamp, each with an oral/nasal, a nasal, and a reinforced endotracheal tube. We performed an end-expiratory hold then clamped the endotracheal tube and disconnected the ventilator. We measured the change in airway pressure and volume for 30 s following the disconnection of the ventilator. Results Airway pressure decreased thirty seconds after disconnection with all combinations of clamp and endotracheal tube. The largest fall in airway pressure (-17.486 cmH2O/s at 5 s and -18.834 cmH2O/s at 30 s) was observed with the plastic clamp combined with the reinforced endotracheal tube. The smallest decrease in airway pressure (0 cmH2O/s at 5 s and -0.163 cmH2O/s at 30 s) was observed using the Extra Corporeal Membrane Oxygenation clamp with the nasal endotracheal tube. Conclusions Only the Extra Corporeal Membrane Oxygenation clamp was efficient. Even with an Extra Corporeal Membrane Oxygenation clamp, it is important to limit the duration the ventilator is disconnected to a few seconds (ideally 5 s).
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Affiliation(s)
- Emanuele Turbil
- Anesthesiology and Intensive care, Università degli Studi di Sassari, Sassari, Italy
| | - Nicolas Terzi
- Médecine Intensive Réanimation, C.H.U de Grenoble-Alpes, Grenoble, France
- University of Grenoble-Alpes, Grenoble, France
| | - Carole Schwebel
- Médecine Intensive Réanimation, C.H.U de Grenoble-Alpes, Grenoble, France
- University of Grenoble-Alpes, Grenoble, France
| | - Martin Cour
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- University of Lyon, Lyon, France
| | - Laurent Argaud
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- University of Lyon, Lyon, France
| | - Claude Guérin
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- University of Lyon, Lyon, France
- INSERM, Créteil, France
- * E-mail:
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Gilder E, Parke RL, Jull A. Endotracheal suction in intensive care: A point prevalence study of current practice in New Zealand and Australia. Aust Crit Care 2019; 32:112-115. [DOI: 10.1016/j.aucc.2018.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/19/2018] [Accepted: 03/01/2018] [Indexed: 11/15/2022] Open
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Nay MA, Auvet A, Mankikian J, Herve V, Dequin PF, Guillon A. Evaluation of a flexible bronchoscope prototype designed for bronchoscopy during mechanical ventilation: a proof-of-concept study. Anaesthesia 2017; 72:719-728. [PMID: 28294285 DOI: 10.1111/anae.13839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 12/13/2022]
Abstract
Bronchoscopy during mechanical ventilation of patients' lungs significantly affects ventilation because of partial obstruction of the tracheal tube, and may thus be omitted in the most severely ill patients. It has not previously been possible to reduce the external diameter of the bronchoscope without reducing the diameter of the suction channel, thus reducing the suctioning capacity of the device. We believed that a better-designed bronchoscope could improve the safety of bronchoscopy in patients whose lungs were ventilated. We designed a flexible bronchoscope prototype with a drumstick-shaped head consisting of a long, thin proximal portion; a short and large distal portion for camera docking; and a large suction channel throughout the length of the device. The aims of our study were to test the impact of our prototype on mechanical ventilation when inserted into the tracheal tube, and to assess suctioning capacity. We first tested the efficiency of the suction channel, and demonstrated that the suction flow of the prototype was similar to that of conventional adult bronchoscopes. We next evaluated the consequences of bronchoscopy when using the prototype on minute ventilation and intrathoracic pressures during mechanical ventilation: firstly, in vitro using a breathing simulator; and secondly, in vivo using a porcine model of pulmonary ventilation. The insertion of adult bronchoscopes into the tracheal tube immediately impaired the protective ventilation strategy employed, whereas the prototype preserved it. For the first time, we have developed an innovative flexible bronchoscope designed for bronchoscopy during invasive mechanical ventilation, that both preserved the protective ventilation strategy, and enabled efficient suction flow.
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Affiliation(s)
- M-A Nay
- CHR Orléans, Service de Réanimation Polyvalente, Université F. Rabelais, Orléans, France
| | - A Auvet
- Service de Réanimation Polyvalente, CHRU de Tours, Université F. Rabelais, Tours, France
| | - J Mankikian
- Service de Pneumologie, CHRU de Tours, Université F. Rabelais, Tours, France
| | - V Herve
- INSERM, U1100, Centre d'Etude des Pathologies Respiratoires, Tours, France
| | - P-F Dequin
- Service de Réanimation Polyvalente, CHRU de Tours, Université F. Rabelais, Tours, France.,INSERM, U1100, Centre d'Etude des Pathologies Respiratoires, Tours, France
| | - A Guillon
- Service de Réanimation Polyvalente, CHRU de Tours, Université F. Rabelais, Tours, France.,INSERM, U1100, Centre d'Etude des Pathologies Respiratoires, Tours, France
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Nakstad ER, Opdahl H, Heyerdahl F, Borchsenius F, Skjønsberg OH. Can ventilator settings reduce the negative effects of endotracheal suctioning? Investigations in a mechanical lung model. BMC Anesthesiol 2016; 16:30. [PMID: 27350249 PMCID: PMC4924309 DOI: 10.1186/s12871-016-0196-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 05/13/2016] [Indexed: 11/17/2022] Open
Abstract
Background The insertion of suction devices through endotracheal tubes (ETTs) increases airway resistance and the subsequent suctioning may reduce airway pressures and facilitate atelectasis. The aim of this study was to investigate how airway pressures and tidal volumes change when different combinations of suction equipment and ETT sizes are used, and to what extent unfavorable effects can be ameliorated by choice of ventilator settings. Methods A mechanical ventilator was connected to a lung model by ETTs of 9 mm, 8 mm or 7 mm internal diameter (ID) with a pressure transducer inserted distal to the ETT. The effects of suction procedures with bronchoscope and closed catheter systems were investigated during pressure controlled ventilation (PCV) and volume controlled ventilation (VCV). In each mode, the effects of changes in inspiration:expiration (I:E) ratio, trigger sensitivity and suction pressure were examined. Results The variables that contributed most to negative model airway pressures and loss of tidal volume during suctioning were (in descending order); 1) Small-size ETTs (7–8 mm ID) combined with large diameter suction devices (14–16 Fr); 2) inverse I:E ratio ventilation (in VCV); 3) negative ventilator trigger sensitivity; and 4) strong suction pressure. The pressure changes observed distal to the ETTs were not identical to those detected by the ventilator. Conclusions Negative model airway pressure was induced by suctioning through small-size ETTs. The most extreme pressure and volume changes were ameliorated when conventional ventilator settings were used, such as PCV mode with short inspiration time and a trigger function sensitive to flow changes. Electronic supplementary material The online version of this article (doi:10.1186/s12871-016-0196-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Espen R Nakstad
- Department of Acute Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway. .,Department of Pulmonary Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway.
| | - Helge Opdahl
- Department of Acute Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Fridtjof Heyerdahl
- Department of Acute Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Fredrik Borchsenius
- Department of Pulmonary Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Ole H Skjønsberg
- Department of Pulmonary Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway.,University of Oslo, Oslo, Norway
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Do TN, Seah TET, Phee SJ. Design and Control of a Mechatronic Tracheostomy Tube for Automated Tracheal Suctioning. IEEE Trans Biomed Eng 2016; 63:1229-1238. [PMID: 26485352 PMCID: PMC7186034 DOI: 10.1109/tbme.2015.2491327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 08/22/2015] [Accepted: 10/13/2015] [Indexed: 11/10/2022]
Abstract
GOAL Mechanical ventilation is required to aid patients with breathing difficulty to breathe more comfortably. A tracheostomy tube inserted through an opening in the patient neck into the trachea is connected to a ventilator for suctioning. Currently, nurses spend millions of person-hours yearly to perform this task. To save significant person-hours, an automated mechatronic tracheostomy system is needed. This system allows for relieving nurses and other carers from the millions of person-hours spent yearly on tracheal suctioning. In addition, it will result in huge healthcare cost savings. METHODS We introduce a novel mechatronic tracheostomy system including the development of a long suction catheter, automatic suctioning mechanisms, and relevant control approaches to perform tracheal suctioning automatically. To stop the catheter at a desired position, two approaches are introduced: 1) Based on the known travel length of the catheter tip; 2) Based on a new sensing device integrated at the catheter tip. It is known that backlash nonlinearity between the suction catheter and its conduit as well as in the gear system of the actuator are unavoidable. They cause difficulties to control the exact position of the catheter tip. For the former case, we develop an approximate model of backlash and a direct inverse scheme to enhance the system performances. The scheme does not require any complex inversions of the backlash model and allows easy implementations. For the latter case, a new sensing device integrated into the suction catheter tip is developed and backlash compensation controls are avoided. RESULTS Automated suctioning validations are successfully carried out on the proposed experimental system. Comparisons and discussions are also introduced. SIGNIFICANCE The results demonstrate a significant contribution and potential benefits to the mechanical ventilation areas.
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Affiliation(s)
- Thanh Nho Do
- School of Mechanical and Aerospace
EngineeringNanyang Technological UniversitySingapore639798
| | | | - Soo Jay Phee
- School of Mechanical and Aerospace EngineeringNanyang Technological University
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Nay MA, Mankikian J, Auvet A, Dequin PF, Guillon A. The effect of fibreoptic bronchoscopy in acute respiratory distress syndrome: experimental evidence from a lung model. Anaesthesia 2015; 71:185-91. [DOI: 10.1111/anae.13274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 11/27/2022]
Affiliation(s)
- M.-A. Nay
- Centre Hospitalier Régional Universitaire de Tours; Service de Réanimation Polyvalente; Tours France
| | - J. Mankikian
- Centre Hospitalier Régional Universitaire de Tours; Service de Réanimation Polyvalente; Tours France
| | - A. Auvet
- Centre Hospitalier Régional Universitaire de Tours; Service de Réanimation Polyvalente; Tours France
- French Institute of Health and Medical Research; Centre d'Etude des Pathologies Respiratoires; Tours France
| | - P.-F. Dequin
- French Institute of Health and Medical Research; Centre d'Etude des Pathologies Respiratoires; Tours France
- Centre Hospitalier Régional Universitaire de Tours; Service de Réanimation Polyvalente; Tours France
| | - A. Guillon
- Centre Hospitalier Régional Universitaire de Tours; Service de Réanimation Polyvalente; Tours France
- French Institute of Health and Medical Research; Centre d'Etude des Pathologies Respiratoires; Tours France
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Ziebart A, Garcia-Bardon A, Kamuf J, Thomas R, Liu T, Schad A, Duenges B, David M, Hartmann EK. Pulmonary effects of expiratory-assisted small-lumen ventilation during upper airway obstruction in pigs. Anaesthesia 2015; 70:1171-9. [PMID: 26179167 DOI: 10.1111/anae.13154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 11/28/2022]
Abstract
Novel devices for small-lumen ventilation may enable effective inspiration and expiratory ventilation assistance despite airway obstruction. In this study, we investigated a porcine model of complete upper airway obstruction. After ethical approval, we randomly assigned 13 anaesthetised pigs either to small-lumen ventilation following airway obstruction (n = 8) for 30 min, or to volume-controlled ventilation (sham setting, n = 5). Small-lumen ventilation enabled adequate gas exchange over 30 min. One animal died as a result of a tension pneumothorax in this setting. Redistribution of ventilation from dorsal to central compartments and significant impairment of the distribution of ventilation/perfusion occurred. Histopathology demonstrated considerable lung injury, predominantly through differences in the dorsal dependent lung regions. Small-lumen ventilation maintained adequate gas exchange in a porcine airway obstruction model. The use of this technique for 30 min by inexperienced clinicians was associated with considerable end-expiratory collapse leading to lung injury, and may also carry the risk of severe injury.
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Affiliation(s)
- A Ziebart
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - A Garcia-Bardon
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - J Kamuf
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - R Thomas
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - T Liu
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - A Schad
- Institute of Pathology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - B Duenges
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - M David
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - E K Hartmann
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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