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Raimundo RD, Sato MA, da Silva TD, de Abreu LC, Valenti VE, Riggs DW, Perrow Carll A. Open and Closed Endotracheal Suction Systems Divergently Affect Pulmonary Function in Mechanically Ventilated Subjects. Respir Care 2021; 66:785-792. [PMID: 33688090 PMCID: PMC9994112 DOI: 10.4187/respcare.08511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In mechanically ventilated subjects, intra-tracheal secretions can be aspirated with either open suction systems (OSS) or closed suction systems (CSS). In contrast to CSS, conventional OSS require temporarily disconnecting the patient from the ventilator, which briefly diminishes PEEP and oxygen supply. On the other hand, CSS are more expensive and less effective at aspirating secretions. Thus, it was hypothesized that the 2 procedures differentially affect pulmonary and cardiovascular parameters after suction. METHODS Subjects in the ICU (N = 66) were quasi-randomized for initial treatment with OSS or CSS in a crossover design. To compare the potential for these suction systems to compromise cardiorespiratory stability, changes in cardiopulmonary physiology were assessed from before to just after use of each suction system (three 10-s aspirations). RESULTS For most pulmonary and cardiovascular parameters (ie, peak inspiratory pressure, airway resistance, pressure plateau, heart rate, and arterial pressures), the effects of aspiration inversely correlated with baseline values for that parameter, with a similar regression slope between suction systems. However, when controlling for baseline values, OSS caused significantly greater increases in airway resistance and peak inspiratory pressure (P < .001 and < .01 vs CSS, respectively). CONCLUSIONS Elevated airway resistance prior to endotracheal suction may justify use of a CSS and contraindicate a conventional OSS in mechanically ventilated subjects. Adoption of this approach into clinical guidelines may prevent suction-induced pulmonary injury in subjects, especially for those with underlying diseases involving increased airway resistance or increased alveolar pressure. (ClinicalTrials.gov registration: NCT03256214.).
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Affiliation(s)
- Rodrigo Daminello Raimundo
- Laboratório de delineamento de estudos e escrita científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - Monica Akemi Sato
- Laboratório de delineamento de estudos e escrita científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - Talita Dias da Silva
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo (UFES), Vitória, Espírito Santo, Brazil. Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts.
- Departamento de Cardiologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Faculdade de Medicina, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de delineamento de estudos e escrita científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - Vitor Engrácia Valenti
- Departamento de estudos sobre o Sistema nervoso autonômico, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, São Paulo, Brazil
| | - Daniel William Riggs
- Diabetes and Obesity Center, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Alex Perrow Carll
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo (UFES), Vitória, Espírito Santo, Brazil. Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
- Diabetes and Obesity Center, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky
- Department of Physiology, School of Medicine, University of Louisville, Louisville, Kentucky
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Kacmarek RM, Li Bassi G. Endotracheal tube management during mechanical ventilation: less is more! Intensive Care Med 2019; 45:1632-1634. [PMID: 31531713 DOI: 10.1007/s00134-019-05777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Robert M Kacmarek
- Department of Anesthesiology, Harvard Medical School, Boston, MA, USA. .,Respiratory Care, Massachusetts General Hospital, Boston, MA, USA.
| | - Gianluigi Li Bassi
- Division of Animal Experimentation, Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia.,University of Queensland, Brisbane, Australia.,BITRECS Fellow, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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