SEARCH · PubMed Health

Results for “Suction”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 127 records · Page 7Linked to original sources

PubMed2006

Impact of the suctioning system (open vs. closed) on the incidence of ventilation-associated pneumonia: Meta-analysis of randomized controlled trials.

OBJECTIVE: Ventilation-associated pneumonia (VAP) is a serious complication of patients in intensive care units (ICU) who require mechanical ventilation. The choice of suctioning system (open vs. closed) remains unresolved in evidence-based guidelines. This meta-analysis was carried out to analyze the effect of the type of suctioning system on the incidence of VAP. DESIGN: A search of the literature was used to identify randomized controlled trials addressing this question. A meta-analysis was then performed to calculate the relative risk of ventilation-associated pneumonia acquisition with the two suctioning systems. RESULTS: Nine trials were included, with 648 patients in the open suctioning group and 644 in the closed suctioning group. VAP occurred in 128 (20%) of the open suctioning group and in 120 (19%) in the closed suctioning group (relative risk 0.95). CONCLUSIONS: At a given pneumonia prevalence of 20% in ICU patients there was no significant advantage for the use of either suctioning system in this meta-analysis. The choice of suctioning system should therefore be based on handling, cost, and individual patient's disease until more data are available.

Cross Infection↗

PubMed2001

Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation.

OBJECTIVE: A closed suction system (CS) maintains connection with the mechanical ventilator during tracheal suctioning and is claimed to limit loss in lung volume and oxygenation. We compared changes in lung volume, oxygenation, airway pressure and hemodynamics during endotracheal suctioning performed with CS and with an open suction system (OS). DESIGN: Prospective, randomized study. SETTING: Intensive care unit in a university hospital. PATIENTS: We enrolled ten patients, volume-controlled (VC) ventilated with a Siemens Servo 900 ventilator (PaO2/FIO2 192 +/- 70, PEEP 10.7 +/- 3.9 cmH2O). INTERVENTIONS: We performed four consecutive tracheal suction maneuvers, two with CS and two with OS, at 20-min intervals. During the suction maneuvers continuous suction was applied for 20 s. MEASUREMENTS AND MAIN RESULTS: We measured end-expiratory lung volume changes (delta VL), tidal volume (VTrt), respiratory rate (RR) and minute volume (VErt) by respiratory inductive plethysmography; arterial oxygen saturation (SpO2), airway pressure and arterial pressure (PA). Loss in lung volume during OS (delta VL 1.2 +/- 0.7 l) was significantly higher than during CS (delta VL 0.14 +/- 0.1 l). During OS we observed a marked drop in SpO2, while during CS the change was only minor. During CS ventilation was not interrupted and we observed an immediate increase in RR (due to the activation of the ventilator's trigger), while VTrt decreased, VErt was maintained. CONCLUSIONS: Avoiding suction-related lung volume loss can be helpful in patients with an increased tendency to alveolar collapse; CS allows suctioning while avoiding dramatic drops in lung volumes and seems to be safe during the VC ventilation setting that we used.

Adult↗

PubMedDate not supplied

In situ control of cardiotomy suction reduces blood trauma.

Cardiotomy suction is known for its deleterious effects on formed and unformed blood elements. The authors investigated an "intelligent" remote controlled automatic suction system. A suction cannula with an optic sensor at its tip was connected to a special closed cardiotomy reservoir. Contact with blood immediately generated a reservoir vacuum from 0 to -100 mmHg, permitting aspiration until the blood was no longer detected (automatic shut off). Blood trauma was evaluated in a bovine model, comparing the automatic suction system vs standard continuous aspiration (control) adjusted to -100 mmHg. After full systemic heparinization, five calves (weight, 62.5 +/- 4.4 kg) for the automatic suction system group, and four (weight, 62.8 +/- 5.1 kg) for the control group, were equipped with a jugular cannula connected via a roller pump to the cardiotomy reservoir. Through a small thoracotomy, a standardized hole was created in the right atrium, allowing for a blood loss of approximately 400 ml/min. The suction cannula was placed into the chest cavity in a fixed position. Blood samples were drawn at regular intervals for cell count and chemistry. Lactate dehydrogenase values, for the automatic suction system and the control groups, respectively, expressed as percent of baseline value, were 88 +/- 14 vs 116 +/- 22 after 1 hr; 94 +/- 16 vs 123 +/- 23 after 2 hr; and 97 +/- 19 vs 140 +/- 48 after 3 hr (p < 0.05). Values for free hemoglobin in plasma (percent of baseline value), for the automatic suction system and the control groups, respectively, were 102 +/- 18 vs 200 +/- 69 after 1 hr; 98 +/- 29 vs 163 +/- 37 after 2 hr; and 94 +/- 37 vs 179 +/- 42 after 3 hr (p < 0.05). Compared with a standard continuous aspiration system, in situ regulation of suction significantly reduces blood trauma.

Animals↗

PubMed1979

New endotracheal tube adaptor reducing cardiopulmonary effects of suctioning.

The continuous recordings of arterial oxygen saturation (SaO2) and beat-to-beat heart rate before, during, and after tracheobronchial suctioning were studied in eight preterm infants with severe RDS receiving mechanical ventilation. Two suctioning procedures were alternatively performed in each infant; In procedure A, disconnection of the ventilator and preoxygenation preceded suctioning; in procedure B, a special suction adaptor was used without ventilatory interruption or preoxygenation; 128 suctionings were performed with each procedure and the changes in heart rate (HR) and SaO2 during suctioning were compared. Although in both procedures, HR and SaO2 decreased during suctioning, the degree of bradycardia and arterial blood oxygen desaturation were significantly smaller in magnitude and shorter in duration during procedure B. These data indicate advantages of the suction adaptor in minimizing bradycardia and hypoxia from airway suction.

Bronchi↗

PubMed2001

Blood loss in major liposuction procedures: a comparison study using suction-assisted versus ultrasonically assisted lipoplasty.

The blood loss that accompanies liposuction procedures has always been a concern. Tumescent injection of the targeted area of liposuction with dilute lidocaine and epinephrine solution has minimized intraoperative blood loss. Proponents of a newer ultrasonically assisted lipoplasty technique have claimed many benefits over traditional suction-assisted lipoplasty. However, few quantitative data are available on the intraoperative blood loss and the significance of postoperative anemia using the ultrasonic method. A prospective clinical observational design was used to investigate 38 patients undergoing suction-assisted lipoplasty and 37 patients undergoing ultrasound-assisted lipoplasty in whom the liposuction aspirate was expected to be more than 1000 ml. These patients were investigated with preoperative measurement of hemoglobin, platelet count, prothrombin time, partial thromboplastin time, and postoperative measurement of hemoglobin on the seventh postoperative day. In addition, hemoglobin concentration and whole blood volume were calculated from the infranatant portion of the liposuction aspirate. The mean +/- SD volume of the liposuction aspirate was 2901 +/- 1471 ml for suction-assisted compared with 2741 +/- 1086 ml for ultrasound-assisted lipoplasty. The mean +/- SD of whole blood volume in liposuction aspirate per case was 36 +/- 50.82 ml for suction-assisted lipoplasty and 36 +/- 28.62 ml for ultrasound-assisted lipoplasty. The mean +/- SD of the preoperative hemoglobin concentration was 13.93 +/- 0.99 g/dl for suction-assisted lipoplasty and 14.05 +/- 1.16 g/dl for ultrasound-assisted lipoplasty, whereas the mean +/- SD of the postoperative hemoglobin concentration was 13 +/- 1.42 g/dl for suction-assisted lipoplasty and 13.05 +/- 1.32 g/dl for ultrasound-assisted lipoplasty. The mean decrease in hemoglobin on the seventh postoperative day was 0.93 +/- 0.92 g/dl for suction-assisted lipoplasty and 1 +/- 0.64 g/dl for ultrasound-assisted lipoplasty. The volume of whole blood loss was estimated to be 12.4 ml in each 1000 ml of liposuction aspirate when using suction-assisted lipoplasty versus 13.1 ml when using ultrasound-assisted lipoplasty. All procedures were done under general anesthesia, and patients were discharged home on the same day. No blood transfusion was required. This study shows that blood loss using the ultrasonic technique is slightly higher, though insignificant, than when using suction. However, this study did not demonstrate a difference in the postoperative hemoglobin decrease between the two techniques.

Blood Loss, Surgical↗

PubMed2004

Closed suction or penrose drainage after partial nephrectomy: does it matter?

PURPOSE: Prospective studies in the general surgery literature have shown fewer wound related complications with closed suction drainage than with open passive drainage. Nevertheless, some urologists avoid closed suction drains after partial nephrectomy mainly because of a theoretical increased risk of a prolonged urinary leak or delayed hemorrhage. MATERIALS AND METHODS: We reviewed the records of 184 patients who underwent 197 consecutive partial nephrectomies at our institution. Closed suction or open passive (Penrose) drainage was used based on surgeon preference. Drain type was compared with duration of use and the incidence of relevant complications. RESULTS: A Penrose drain was used in 37.6% (74 of 197) of partial nephrectomies and a closed suction drain was used in 62.4% (123). Clinical characteristics were equivalent between both groups, including age, body mass index, tumor size (mean 3.1 cm), number of renal tumors excised, estimated blood loss and operative time. There was no statistically significant difference in the duration of drainage between the Penrose group (mean 7.1 days) and the closed suction group (7.8 days). While we found variation in the incidence of relevant complications by drain type, none of these differences was statistically significant. Complications included prolonged urinary drainage in 7.6% of cases (8.9% closed suction, 5.4% Penrose), wound infection or perinephric abscess in 3.6% (2.4% closed suction, 5.4% Penrose) and delayed hemorrhage in 1.5% (2.4% closed suction, 0 Penrose). CONCLUSIONS: No statistically significant differences in postoperative morbidity were observed between the use of closed suction or Penrose retroperitoneal drains after partial nephrectomy.

Adolescent↗

PubMed2005

Requirement for 100% oxygen before and after closed suction.

AIM: This paper reports an experimental study to determine whether giving 100% oxygen for 1 minute before and after closed suctioning is required. BACKGROUND: Some studies suggest that patients receiving closed suction do not require preoxygenation to minimize desaturation. METHODS: The study was conducted in 2002, with 30 patients receiving mechanical ventilation who had various positive end-expiratory levels. Two suctioning methods were used for each patient: one involving administration of 100% oxygen for 1 minute before and after suctioning and the other without hyperoxygenation. Samples of arterial blood gases were taken before and after suctioning. Heart rate, arterial oxygen saturation and mean arterial pressure measures were documented before, immediately after, 30 and 60 seconds after suctioning. RESULTS: Levels of partial oxygen pressure, arterial oxygen saturation and mean arterial pressure were significantly higher in patients who received 100% oxygen for 1 minute before and after suction, whereas partial carbon dioxide pressure and heart rate were similar in the two groups. CONCLUSIONS: In patients who did not receive 100% oxygen before and after closed suctioning, no significant falls in partial oxygen pressure and oxygen saturation were seen. A small number of patients were hypoxaemic before suctioning, and not [corrected] giving 100% oxygen might be deleterious for this category.

Adult↗

PubMed1997

Mechanical ventilation with or without daily changes of in-line suction catheters.

The purpose of this study was to determine the safety and cost-effectiveness of not routinely changing in-line suction catheters for patients requiring mechanical ventilation. Patients were randomly assigned to receive either no routine in-line suction catheter changes (n = 258) or in-line suction catheter changes every 24 h (n = 263). The main outcome measure was the incidence of ventilator-associated pneumonia. Other outcomes evaluated included hospital mortality, acquired organ system derangements, duration of mechanical ventilation, lengths of intensive care and hospital stay, and the cost for in-line suction catheters. Ventilator-associated pneumonia was seen in 38 patients (14.7%) receiving no routine in-line suction catheter changes and in 39 patients (14.8%) receiving in-line suction catheter changes every 24 h (relative risk, 0.99; 95% CI, 0.66 to 1.50). No statistically significant differences for hospital mortality, lengths of stay, the number of acquired organ system derangements, death in patients with ventilator-associated pneumonia, or mortality directly attributed to ventilator-associated pneumonia were found between the two treatment groups. Patients receiving in-line suction catheter changes every 24 h had 1,224 catheter changes costing a total of $11,016; patients receiving no routine in-line suction catheter changes had a total of 93 catheter changes costing $837. Our findings suggest that the elimination of routine in-line suction catheter changes is safe and can reduce the costs associated with providing mechanical ventilation.

Adult↗

PubMed2000

A computed tomographic scan assessment of endotracheal suctioning-induced bronchoconstriction in ventilated sheep.

This study was directed at assessing changes in bronchial cross-sectional surface areas (BCSA) and in respiratory resistance induced by endotracheal suctioning in nine anesthetized sheep. Cardiorespiratory parameters (Swan-Ganz catheter), respiratory resistance (inspiratory occlusion technique), BCSA, and lung aeration (computed tomography) were studied at baseline, during endotracheal suctioning, and after 20 consecutive hyperinflations. Measurements performed initially at an inspired oxygen fraction (FI(O(2))) of 0.3 were repeated at an FI(O(2)) of 1.0. At an FI(O(2)) of 0.3, endotracheal suctioning resulted in atelectasis, a reduction in BCSA of 29 +/- 23% (mean +/- SD), a decrease in arterial oxygen saturation from 95 +/- 3% to 87 +/- 12% (p = 0.02), an increase in venous admixture from 19 +/- 10% to 31 +/- 19% (p = 0. 006), and an increase in lung tissue resistance (DR(rs)) (p = 0. 0003). At an FI(O(2)) of 1.0, despite an extension of atelectasis and an increase in pulmonary shunt from 19 +/- 5% to 36 +/- 2% (p < 0.0001), arterial O(2) desaturation was prevented and BCSA decreased by only 7 +/- 32%. A recruitment maneuver after endotracheal suctioning entirely reversed the suctioning-induced increase in DR(rs) and atelectasis. In three lidocaine-pretreated sheep, the endotracheal suctioning-induced reduction of BCSA was entirely prevented. These data suggest that the endotracheal suctioning-induced decrease in BCSA is related to atelectasis and bronchoconstriction. Both effects can be reversed by hyperoxygenation maneuver before suctioning in combination with recruitment maneuver after suctioning.

Airway Resistance↗

PubMed2004

Side effects of endotracheal suction in pressure- and volume-controlled ventilation.

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.

Animals↗

PubMed2002

Ultrasound biomicroscopic findings in rabbit eyes undergoing scleral suction during lamellar refractive surgery.

PURPOSE: To evaluate changes of the central anterior chamber depth, cilio-angular cross-sectional surface area, and intraocular pressure in rabbit eyes undergoing application of the scleral suction ring during lamellar refractive surgery. METHODS: Thirty eyes of 30 rabbits were used in the study. The eyes were assigned to one of the following five surgical groups: group 1, no application of the suction ring; group 2, suction for 2 minutes; group 3, suction for 1 minute; group 4, suction for 20 seconds; and group 5, suction for 10 seconds. Ultrasound biomicroscopy (UBM) was performed to determine tomographic features, including central anterior chamber depth, cross-sectional surface area of the ciliary body, and chamber angle structure before and 10 minutes, 1 hour, 2 hours, 1 day, 2 days, 1 week, and 2 weeks after surgery. Intraocular pressure was also measured at each of these time points. RESULTS: Swelling of the ciliary body occurred in groups 2 to 5 of eyes from 10 minutes up to 1 day after the operation, and its severity was positively related to the duration of suction. Shallowness of the chamber angle was positively related to swelling. All UBM-detectable changes became insignificant compared with baseline values at 2 days after the operation. No significant change was found in the central anterior chamber depth and intraocular pressure during the 2-week postoperative observation period. CONCLUSIONS: Transient change in the ciliary body and the chamber angle occurred frequently after application of the scleral suction ring during lamellar refractive surgery in rabbit eyes. Its severity was positively related to the duration of suction. Swelling of the ciliary body corresponded with the shallowness of the chamber angle without alteration of the corneal-lenticular distance and intraocular pressure.

Animals↗

PubMed1993

Differential effects of compression and suction ophthalmodynamometry on the scotopic blue-flash electroretinogram.

Several studies have investigated the effect of elevated intraocular pressure with reduced ocular perfusion pressure on visual neural function by means of compression and suction ophthalmodynamometry. We compared the effects of nominally equivalent reductions in the ocular perfusion pressure induced by compression and suction ophthalmodynamometry retinal function as measured by flash electroretinography. Scotopic blue-flash electroretinograms were recorded in five subjects for baseline conditions; during a 40% reduction in the ocular perfusion pressure effected in a first test session by compression ophthalmodynamometry; and then in a second test session some 4 hours later by suction ophthalmodynamometry. Fifteen consecutive electroretinographic sets were recorded during scleral compression or suction, and also after compression or suction was removed. Compression and suction ophthalmodynamometry decreased the electroretinogram b-wave to different degrees; overall, the electroretinogram was attenuated more by compression than by suction ophthalmodynamometry. In the recovery phase, the group averaged b-wave quickly increased to exceed baseline after both scleral compression and suction. The trends for prolonged implicit times over the duration of the study were similar for compression and suction ophthalmodynamometry.

Adult↗

PubMed1995

An artificial neural network-based noninvasive detector for suction and left atrium pressure in the control of rotary blood pumps: an in vitro study.

Rotary blood pumps are used in clinical applications to assist circulation via pumping blood from the left atrium to the aorta. Negative inflow pressures at high flow rates can cause suction of the cannula in the left atrium with deleterious effects on the atrial wall, the blood, and the lung. Therefore, stable and reliable detection of suction and the prediction of the left atrium pressure (LAP) would be of major interest for the control of these pumps. This work reports about an in vitro study of such a detector based on artificial neural networks (ANN). In the first project phase, an ANN was used to estimate the LAP based on pump speed, pump flow, and aortic pressure, obtained from a mock circulation. The inputs for the ANN were 11 characteristic values computed from these three parameters. In the second phase, another ANN was trained to classify various system states, such as suction, danger of suction (a state close to actual suction), and no suction. The first ANN was able to estimate the LAP with an accuracy of +/- 1.8 mm Hg. The discrimination of suction versus the other two states could be performed with a sensitivity and specificity of about 95% while the more interesting task of distinguishing danger of suction from no suction reached a sensitivity and specificity of about 65% (leaving 25% of each class unclassified and 10% of each class incorrectly classified).(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Function↗

PubMedDate not supplied

Differential modulation of transforming growth factor-beta by betamethasone-17- valerate and isotretinoin: corticosteroid decreases and isotretinoin increases the level of transforming growth factor-beta in suction blister fluid.

Retinoids and glucocorticoids are known to have a potential to modulate the expression of transforming growth factor-beta (TGF-beta). We investigated the effect of oral isotretinoin (13-cis-retinoic acid) on the expression of two distinct isoforms of TGF-beta, TGF-beta1 and TGF-beta2, in suction blister fluid and serum in acne patients. We also investigated the effect of topical glucocorticoid (betamethasone-17-valerate) and age on suction blister fluid TGF-beta1 in healthy volunteers. Six weeks of isotretinoin treatment caused a statistically significant 19% increase in suction blister fluid TGF-beta1. The suction blister fluid TGF-beta2 level remained below the sensitivity level of the immunoassay in many cases. Isotretinoin did not affect the serum TGF-beta1 or TGF-beta2 level. Betamethasone-17-valerate pretreatment for 3 days twice a day caused a statistically significant 17% decrease in suction blister fluid TGF-beta1. The active form of TGF-beta1 represented 5% of the total TGF-beta1 in suction blister fluid. Our diffusion calculations suggest that all TGF-beta1 and TGF-beta2 detected in suction blister fluid have diffused from systemic circulation. The increase in suction blister fluid TGF-beta1 after isotretinoin treatment seems to be of local origin, while the decrease in suction blister fluid TGF-beta1 after glucocorticoid pretreatment seems to be due to glucocorticoid-induced vasoconstriction resulting in decreased diffusion of TGF-beta1 from the circulation. Modulation of local interstitial fluid TGF-beta1 concentration may be one mechanism by which isotretinoin and glucocorticoids mediate their effects in skin.

Acne Vulgaris↗

PubMedDate not supplied

The influence of suction catheter tip design on tracheobronchial trauma and fluid aspiration efficiency.

The suctioning efficiency and trauma-producing characteristics of five commercially available tracheobronchial suction catheters (Pharmaseal Tri-Flo, NCC Gentle-Flo, Argyle Aero-Flo, Argyle Dual Side-Hole, and Pharmaseal Whistle-Tip) were experimentally evaluated in anesthetized healthy dogs. The tendency of catheters to invaginate or "grab" tracheobronchial mucosa was observed with a bronchofiberscope during suctioning. Mucosal grabbing was seldom seen even at high (greater than 300 torr) vacuum levels with the cateter tip in the trachea. All catheters were observed to invaginate mucosa in lobar and segmental bronchi, with the frequency of grabbing being a function of airway anatomy, airway size, catheter orientation, tip design, and vacuum level. Catheters with multiple side-holes appeared to invaginate mucosa less frequently than the single side-hole catheter. Repeated suctioning of anesthetized healthy dogs followed by tracheobronchial excision, gross observation, and histologic examination of mucosal tissue biopsies demonstrated significant differences in the frequency and severity of lesions caused by the tracheobronchial suction procedure. All catheters were observed to damage airway lining, the damage related to multiple side-hole catheters appearing to be associated entirely with the act of cateter insertion and not with the application of vacuum. Only the Whistle-Tip design produced measurable damage beyond that related to catheter insertion. The average tip-suctioning effectiveness for each catheter, determined in vitro by aspirating a thin, uniform layer of simulated mucus, was found to be significantly higher for the Tri-Flo and Whistle-Tip catheters than the others, the Aero-Flo being least effective. Preliminary attempts to demonstrate this difference in suctioning effectiveness by comparing the performance of the catheters which displayed the highest and lowest tip suction effectiveness in a standardized clinical suctioning procedure revealed no significant difference in the percentage of mucus removed by either catheter. Additional studies should clarify this apparent contradiction.

Animals↗

PubMed1988

Shallow versus deep endotracheal suctioning in young rabbits: pathologic effects on the tracheobronchial wall.

The traditional technique for endotracheal suctioning of intubated neonates consists of inserting a catheter until resistance is met, withdrawing slightly, and applying suction. The extent of tissue damage caused by the traditional (deep) technique v that caused by an alternative shallow technique was studied with an animal model. Six 3-week-old rabbits were anesthetized, intubated, and suctioned every 15 minutes for six hours by neonatal intensive care unit nurses who were unaware of the study purpose. Three rabbits were suctioned by means of the deep technique, whereas the other three received shallow suctioning achieved by inserting the catheter no further than a premeasured distance. Light microscopy showed significantly increased necrosis and inflammation following deep suctioning. Electron microscopy revealed greater loss of cilia and increased mucus with the deep technique. To confirm our initial assumption that the deep technique is still used extensively by neonatal intensive care units throughout the country, a mail survey was conducted. Of the 405 (43%) neonatal intensive care unit physicians who responded, 82% reported frequent or exclusive use of the deep technique for routine suctioning. In this study, the fact that deep suctioning results in significantly more tracheobronchial pathology than does a shallow, premeasured technique is shown. It is recommended that nurseries change their current practice and adopt the shallow technique for routine suctioning of intubated neonates.

Animals↗

PubMed2001

Tracheal suctioning without disconnection in intubated ventilated neonates.

BACKGROUND: Assisted mechanical ventilation is the mainstay of management of a variety of conditions affecting the neonate. However there are a number of potential hazards associated with this life saving intervention. New suctioning techniques have been introduced into clinical practice which aim to prevent or reduce these untoward effects. OBJECTIVES: To assess the effects of endotracheal suctioning without disconnection in intubated ventilated neonates. SEARCH STRATEGY: The review has drawn on the search strategy for the Cochrane Neonatal Review Group. A comprehensive search of MEDLINE, Cochrane Library, MEDLINE and CINAHL databases was undertaken by the reviewers. SELECTION CRITERIA: All trials utilizing random or quasi-random patient allocation in which suctioning with or without disconnection from the ventilator is compared in the neonatal population. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Neonatal Group were used. Each author reviewed trials for eligibility and quality and extracted data separately, then compared and resolved differences. Analysis was performed using the fixed effects model and outcomes were reported using relative risk for categorical data and weighted mean difference for outcomes measured on a continuous scale. MAIN RESULTS: Two trials (22 infants) were included in this review. The trials employed a cross-over design in which suctioning with or without disconnection was compared. Suctioning without disconnection resulted in a reduction in episodes of hypoxia (RR 0.30, 95% CI 0.11, 0.80) and a smaller percentage decrease in the TcPO2 (WMD 18.5%, 95% CI 8.11, 28.89). There were also fewer infants who experienced episodes where TcPO2 decreased by > 10% (RR 0.36, 95% CI 0.17, 0.79). Suctioning without disconnection resulted in a smaller percentage decrease in heart rate (WMD 11.53%, 95% CI 3.64, 19.43) and a reduction in the number of infants experiencing a decrease in heart rate by > 10% (RR 0.56, 95% CI 0.32, 0.99). REVIEWER'S CONCLUSIONS: Based upon the results of this review, there is insufficient evidence to decide between endotracheal suctioning with or without disconnection. There is, however, evidence of some benefit from performing suctioning without disconnection for some specific short-term outcomes. Further research should be undertaken to fully assess this practice with particular focus on extremely low birth weight infants and different modes of mechanical ventilation, and to address clinically important outcomes.

Cross-Over Studies↗

PubMed2003

Patient recollection of airway suctioning in the ICU: routine versus a minimally invasive procedure.

OBJECTIVE: Many patients have an unpleasant recollection of routine endotracheal suctioning after discharge from the Intensive Care Unit (ICU). We hypothesized that through minimally invasive airway suctioning discomfort and stress may be prevented, resulting in less recollection. DESIGN: A prospective randomized clinical trial. SETTING: Two ICUs at the University Hospital of Groningen, the Netherlands. PATIENTS AND PARTICIPANTS: Adult patients with an intubation period exceeding 24 h were included. INTERVENTIONS: Patients received either routine endotracheal suctioning (RES) or minimally invasive airway suctioning (MIAS) during the duration of intubation. MEASUREMENTS AND RESULTS: Within 3 days after ICU discharge all patients were interviewed, regarding recollection and discomfort of suctioning. The level of discomfort was quantified on a visual analogue scale (VAS). We analyzed data from 208 patients (RES: n=113, and MIAS: n=95). A significantly lower prevalence of recollection of airway suctioning was found in the MIAS group (20%) compared to the RES group (41%) (P-value =0.001). No significant difference in level of discomfort was found between the RES and the MIAS group (P-value =0.136). CONCLUSIONS: Minimally invasive airway suctioning results in a lower prevalence of recollection of airway suction than in RES, but not in discomfort.

Chi-Square Distribution↗