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PubMedDate not supplied

Suction detection for the MicroMed DeBakey Left Ventricular Assist Device.

The MicroMed DeBakey Ventricular Assist Device (MicroMed Technology, Inc., Houston, TX) is a continuous axial flow pump designed for long-term circulatory support. The system received CE approval in 2001 as a bridge to transplantation and in 2004 as an alternative to transplantation. Low volume in the left ventricle or immoderate pump speed may cause ventricular collapse due to excessive suction. Suction causes decreased flow and may result in patient discomfort. Therefore, detection of this critical condition and immediate adaptive control of the device is desired. The purpose of this study is to evaluate and validate system parameters suitable for the reliable detection of suction. In vitro studies have been performed with a mock loop allowing pulsatile and nonpulsatile flow. Evidence of suction is clearly shown by the flow waveform reported by the implanted flow probe of the system. For redundancy to the implanted flow probe, it would be desirable to use the electronic motor signals of the pump for suction detection. The continuously accessible signals are motor current consumption and rotor/impeller speed. The influence of suction on these parameters has been investigated over a wide range of hydrodynamic conditions, and the significance of the respective signals individually or in combination has been explored. The reference signal for this analysis was the flow waveform of the ultrasonic probe. To achieve high reliability under both pulsatile and nonpulsatile conditions, it was determined that motor speed and current should be used concurrently for suction detection. Using the amplified differentiated current and speed signals, a suction-detection algorithm has been optimized, taking into account two different working points, defined by the value of the current input. The safety of this algorithm has been proven in vitro under pulsatile and nonpulsatile conditions over the full spectrum of possible speed and differential pressure variations. The algorithm described herein may be best utilized to provide redundancy to the existing flow based algorithm.

Algorithms↗

PubMed1993

Head-injured adults: recommendations for endotracheal suctioning.

Endotracheal suctioning (ETS) is a conventional nursing intervention used to decrease pulmonary complications in the critically ill patient. ETS provides a particular dilemma for the head-injured patient because it increases intracranial pressure and may put the patient at increased risk for intracranial hypertension and cerebral ischemia. Research in endotracheal suctioning targets understanding the ETS response in the severely head-injured patient. This article reviews the major research focused on suctioning the head-injured patient. The guidelines for practice based on this research include preoxygenating patients prior to suctioning, limiting suction duration to 10 seconds, limiting suction passes to 1-2 per procedure, using hyperventilation with caution, not rotating the head, keeping negative suction pressure under 120 mm Hg, and not using suction catheters with outer to inner diameter ratios greater than .50.

Brain Damage, Chronic↗

PubMed1978

Is nasogastric suction necessary in acute pancreatitis?

Fifty-eight patients with mild to moderately severe acute pancreatitis were randomly allocated to treatment with or without nasogastric suction (27 and 31 patients respectively). Intravenous fluids and pethidine hydrochloride were also given. The two groups were comparable clinically at the start of the study. There were no differences between the two groups in the mean duration of the following features: abdominal pain or tenderness; absence of bowel movements; raised serum amylase concentration; time to resumption of oral feeding; and days in hospital. Prolonged hyperamylasaemia (serum amylase greater than 0.33 mU/l) occurred in one patient in the suction group and in three patients in the non-suction group. A mild recurrence of abdominal pain after resumption of oral feeding occurred in three patients in the suction group and in two patients in the non-suction group. Two patients in the suction group developed overt consumption coagulopathy and two others pulmonary complications. No patient in the non-suction group had complications. The findings suggest that most patients with mild to moderately severe acute pancreatitis do not benefit from nasogastric suction. The procedure should be elective rather than mandatory in treating this condition.

Acute Disease↗

PubMed2003

Endotracheal suctioning with or without instillation of isotonic sodium chloride solution in critically ill children.

BACKGROUND: Instillation of isotonic sodium chloride solution for endotracheal tube suctioning is controversial. Research has focused on the effect of such instillation in adults; no studies in children have been published. OBJECTIVES: (1) To describe differences in oxygen saturation depending on whether or not isotonic sodium chloride solution is instilled during suctioning and (2) to describe the rates of occlusion of endotracheal tubes and nosocomial pneumonia. METHODS: A convenience sample of 24 critically ill patients were enrolled before having suctioning and after informed consent had been given. Ages ranged from 10 weeks to 14 years. Patients were randomized to 1 of 2 groups. In group 1, subjects received between 0.5 and 2.0 mL of isotonic sodium chloride solution, depending on their age, once per suctioning episode. In group 2, subjects received no such solution. A total of 104 suctioning episodes were analyzed. Oxygen saturation was recorded at predetermined intervals before and for 10 minutes after suctioning. Occlusion of endotracheal tubes and rates of nosocomial pneumonia also were compared. RESULTS: Patients who had isotonic sodium chloride solution instilled experienced significantly greater oxygen desaturation 1 and 2 minutes after suctioning than did patients who did not. No occlusions of endotracheal tubes and no cases of nosocomial pneumonia occurred in either group. CONCLUSIONS: Results of this study support a growing body of evidence that instillation of isotonic sodium chloride solution during endotracheal tube suctioning may not be beneficial and actually may be harmful.

Adolescent↗

PubMed1992

Effects of saline instillation during tracheal suction on lung mechanics in newborn infants.

To evaluate the effect of saline instillation prior to tracheal suction on lung mechanics in mechanically ventilated newborn infants, we studied pulmonary mechanics in nine infants with respiratory distress syndrome (RDS) and nine infants with meconium-aspiration syndrome (MAS) at a mean postnatal age of 3 days. Pulmonary mechanics were measured at 10 minutes prior to, and at 10, 20, and 30 minutes after tracheal suction with saline instillation. Suction and study protocol were repeated within 12 hours without saline instillation. The sequence of the study with and without saline instillation was randomly assigned. In infants with RDS, tracheal suction had no effect on pulmonary compliance or airway resistance with and without saline instillation. In infants with MAS, there was no change in compliance after tracheal suction with and without saline instillation. Airway resistance decreased by 35% after tracheal suction with saline instillation in infants with MAS; tracheal suction without saline instillation had no effect on airway resistance. We conclude that saline instillation into trachea as commonly done during tracheal suction has no deleterious effects on lung mechanics in newborn infants.

Airway Resistance↗

PubMed1992

[Endotracheal suctioning using a 24-hour continuous system. Can costs and waste products be reduced?].

Suctioning of the airways is often required in critically ill, intubated, or tracheotomised patients. In addition to the primary cost of these disposable materials, expenditures for waste disposal and environmental problems due to plastics should also be considered. In this study, the primary costs and amount of waste products of the closed suction system "Trach Care" were compared with a conventional disposable system. Other advantages and disadvantages of a closed suction system are discussed. METHODS. In this prospective, randomised investigation, both the open disposable suction system and the closed Trach Care system were used, in 60 patients (30 in each group) who were intubated for 1 week or more. During the first 7 days, we counted the number of times endotracheal suctioning was performed and measured the time it took. The costs of purchasing the systems, amounts of waste products, and costs of disposal were compared. RESULTS. The frequency of endotracheal suctioning was quite different from patient to patient and varied from 6 to 41 times per day. On average it was necessary 15 times per day per patient in both groups. Using the disposable system, a mean time of 3.5 min was measured in contrast to 2.5 min with the closed system. The costs of purchase were much lower with the disposable system taking into account all materials needed (17.36 DM vs 53.36 DM per day), whereas the weight of litter produced by the closed system was lower (429 g vs 745 g per day), the costs of disposal being accordingly different. During endotracheal suctioning O2 desaturation was not observed with the closed system, whereas in patients with acute respiratory failure O2 saturation fell rapidly from 90% to as far as 70% when a disposable system was used. CONCLUSION. The closed Trach Care suction system is more expensive to acquire, but may reduce the risk of exogenous nosocomial pneumonias as disconnections from the ventilator are minimised. The workload, weight of waste products, and costs of disposal are lower using the Trach Care system. From the physician's viewpoint, the main advantage of the Trach Care system becomes evident in patients with acute respiratory failure and patients with elevated intracranial pressure. In these cases, we now favor the Trach Care system as a matter of principle.

Anesthesiology↗

PubMed1991

[The suction effusion fluid is useful as a sample for blood biochemistry].

We examined whether the suction effusion fluid could be used as a new sample for blood biochemistry. The fluid was obtained from the skin surface of female mongrel dogs by transcutaneous suction after removal of the horny substance. The appropriate intraluminal pressure for suction was 300 mmHg at which the effusion fluid flow rate was 0.6 microliter/min/cm2. The blood biochemistry examination revealed that the creatinine (Cr) and urea (BUN) concentrations in the suction effusion fluid were similar to those in plasma and that the protein and lipid concentrations were much smaller than those in plasma. The six-hour study showed that the effusion fluid could be obtained for hours at the same skin area and that the Cr and BUN concentrations were consistently close to those in plasma. In uremia models, the Cr and BUN concentration in the suction effusion fluid was similar to and had an extremely high correlation (r = 0.985 and 0.982 respectively) to that in plasma through out the range for clinical practice. The skin biopsy revealed that the regeneration of the horny substance had started at one week after the suction and complete recovery was seen at four weeks. The invasiveness of the suction seemed to be small. The suction effusion fluid is a reliable material for measurement of Cr and BUN in plasma and, as it contains much less proteins and lipids, will be a good sample for biosensors.

Animals↗

PubMed1988

Efficacy of a hyperinflation and hyperoxygenation suctioning intervention.

Limited data are available on the efficacy of a common endotracheal suctioning intervention to prevent decreases in arterial oxygenation (PaO2) after endotracheal suctioning. We evaluated the effect of five hyperinflation breaths with hyperoxygenation, administered before and after endotracheal tube suctioning, in anesthetized, paralyzed sheep with normal lung function and with abnormal lung function induced by pulmonary acid aspiration. Using a second ventilator to deliver hyperinflation and hyperoxygenation prevented PaO2 from falling below control values after endotracheal tube suctioning in animals with either normal or abnormal lung function. The PaO2 rise after hyperinflation and hyperoxygenation in animals with abnormal lung function, however, was less than that observed in animals with normal lung function. Using manual resuscitation bags to deliver the hyperinflation breaths with hyperoxygenation prevented PaO2 from falling below control values after endotracheal suctioning in animals with normal lung function. When lung function was abnormal, however, there were significant PaO2 decreases when manual resuscitation bags were used to deliver the intervention. These results highlight the difference in PaO2 response when hyperinflation and hyperoxygenation suctioning interventions are delivered with mechanical versus manual techniques. These results also emphasize that the response to hyperinflation and hyperoxygenation differs in subjects with normal versus abnormal lung function. Laboratory evaluation of endotracheal tube suctioning interventions should use abnormal lung function models, rather than normal lung function models, to approximate more closely the critically ill patient population that requires suctioning.

Animals↗

PubMedDate not supplied

Mechanisms responsible for the sustained fall in arterial oxygen tension after endotracheal suctioning in dogs.

Because a sustained fall in arterial oxygen tension (PaO2) was observed after endotracheal suctioning in previous studies on anesthetized dogs and in humans, this study was designed to investigate the nature of the fall, its duration, and its response to several challenges. Experiments were performed at weekly intervals using three anesthetized dogs. Each dog was subjected to five experiments. In spontaneously breathing dogs, the duration of the sustained fall after suctioning or after suction catheter insertion without application of suction pressure persisted through 15 minutes. At 30 minutes afterwards, PaO2 had partially or completely returned to control levels. One hyperinflation breath given after suctioning did not produce a lasting reversal of the sustained fall, and pretreatment with isoproterenol mist inhalations failed to prevent the sustained fall. In dogs which were mechanically ventilated both before and after suctioning or catheter insertion without application of suction pressure, three hyperinflations before suctioning or pretreatment with isoproterenol failed to prevent the sustained fall. The data supported the hypothesis that a reflex mechanism, initiated by mechanical stimulation of the airways, was responsible for the sustained fall in PaO2 observed.

Animals↗

PubMed1994

Meconium-stained amniotic fluid and respiratory complications: impact of selective tracheal suction.

OBJECTIVE: To determine prospectively the incidence of several pulmonary diagnoses among infants born through clear or meconium-stained amniotic fluid (AF) managed by a selective approach to tracheal intubation. METHODS: All live births greater than 36 weeks' gestation occurring between January 1990 and December 1992 were included. Diagnostic criteria for several respiratory disorders were determined prospectively and monitored. Infants with light meconium and vigorous infants with moderate to thick meconium were selectively not suctioned. A control group of infants with clear AF matched for gestational age and year of birth was randomly selected for comparison. The incidence and severity of respiratory disease were compared between the groups. RESULTS: Of 4938 live births, 799 (16%) had meconium-stained AF (light, 334; moderate to thick, 465). Compared to 211 infants with moderate to thick meconium selectively not suctioned, 196 suctioned infants had significantly greater rates of abnormal fetal heart rate (FHR) patterns, fetal acidosis, low Apgar scores at 5 minutes, need for resuscitation, and neonatal intensive care unit admission. Meconium aspiration syndrome was significantly more common in suctioned infants as compared to those selectively not suctioned, those with light meconium, and those with clear fluid (11 versus 3 versus 0 versus 0%; P < .01). The need for ventilator or oxygen support was similar between infants with clear fluid, lightly stained fluid, and moderate to thick fluid who were selectively not suctioned, but was significantly greater among suctioned infants (P < .01). CONCLUSIONS: We conclude that a selective approach to tracheal intubation and suction of infants with meconium-stained AF was not associated with increased pulmonary morbidity or mortality. Postnatal management of neonates at greatest risk of meconium aspiration syndrome does not necessarily prevent adverse pulmonary outcome.

Amniotic Fluid↗

PubMed1998

'Suction split' as a routine method to differentiate epidermolysis bullosa acquisita from bullous pemphigoid.

BACKGROUND AND DESIGN: Epidermolysis bullosa acquisita (EBA) and bullous pemphigoid (BP) are diseases with similar clinical, histological, and immunofluorescent findings. Diagnosis requires the use of immunoelectron microscopy, immunoprecipitation or immunoblotting, but in recent years the differential diagnosis has been based on a cheaper technique named salt split skin. This study demonstrates that with a suction blister the fracture is at the same level as that obtained with the sodium split method and that it is also faster and cheaper. Suction blisters on normal skin and autoimmune perilesional bullous lesions, obtained with a hand vacuum pump, were studied by direct immunofluorescence and electron microscopy to evaluate the level of the split on normal suction split skin. Normal human split skin was also used as a substrate for an indirect immunofluorescent study using sera of patients with BP (68 sera), EBA (10 sera) and cicatricial pemphigoid (CP) (16 sera). Direct immunofluorescent examination was also done on perilesional skin after artificial separation obtained with a hand-vacuum pump in patients with the same diseases listed above (32 BP, 11 CP, 6 EBA). RESULTS: On normal human skin split by suction or sodium chloride (NaCl; 1 mol/l) direct immunofluorescence and electron microscopy demonstrated that the split is at the lamina lucida level. Indirect immunofluorescent study of both normal human skin and perilesional skin split using suction as a substrate showed IgG deposits localized on the floor of the suction blister in all cases of EBA, whereas in over 88% of cases of BP and in over 62% of CP the IgG were localized on the roof. Similar results were obtained with direct immunofluorescence in perilesional skin. CONCLUSIONS: 'Suction split' represents a simple technique to differentiate EBA from BP. This method provides final response in a few hours compared to at least 1-2 days with the sodium split method. Furthermore, the suction split method is cheaper and the tissue can be re-utilized for molecular biology and immunohistochemical studies.

Diagnosis, Differential↗

PubMed1998

Instillation of normal saline before suctioning in patients with pulmonary infections: a prospective randomized controlled trial.

OBJECTIVE: To determine the effect of instillation of normal saline before suctioning on oxygen saturation, heart rate, and blood pressure in patients with pulmonary infections. METHODS: A prospective randomized controlled trial was conducted in the surgical, medical, and burn/trauma ICUs of an academic medical center. Eighteen men and 11 women (mean age = 60 years) receiving mechanical ventilation who met the criteria for pulmonary infection were randomly assigned to 2 groups. One group had instillation of a 5-mL bolus of normal saline before suctioning; the other did not. Suctioning was done as needed during an 8-to 12-hour period. Oxygen saturation, heart rate, and blood pressure were measured noninvasively immediately before and after suctioning, at 1-minute intervals for 5 minutes after suctioning, and at 10 minutes after suctioning. RESULTS: Instillation of normal saline had an adverse effect on oxygen saturation, which worsened over time. Differences in saturation between the 2 groups were significant at 4, 5, and 10 minutes after suctioning. Differences in heart rate and blood pressure were not significant. CONCLUSION: Instillation of normal saline before suctioning has an adverse effect on oxygen saturation and should not be used routinely in patients receiving mechanical ventilation who have pulmonary infection.

Adult↗

PubMed2003

Efficiency of a gas diffuser and influence of suction in carbon dioxide deairing of a cardiothoracic wound cavity model.

OBJECTIVE: In cardiac surgery, insufflation of carbon dioxide is used for deairing of the heart and great vessels. The aim of this study was to assess a new insufflation device for efficient deairing and to study the influence of suction. METHODS: We measured the content of remaining air at two positions in the cardiothoracic wound model. A new insufflation device, a gas diffuser, was compared with a conventional 0.25-inch tube. Carbon dioxide flow (5 and 10 L/min) and suction (0, 1.5, 10, and 25 L/min) were varied. Suction was studied in combination with the gas diffuser. RESULTS: With the tube the median air content in the wound model was 19.5% to 51.7% at the studied carbon dioxide flows, whereas with the gas diffuser the median air content was no greater than 1.2% at 5 L/min and no greater than 0.31% at 10 L/min (P <.001). When suction of 1.5 L/min was applied, the median air content in the model remained low (<or =1.0%) at both carbon dioxide flows. With suction of 10 L/min the median air content was still low (<or =0.50%) at a simultaneous carbon dioxide flow of 10 L/min. Conversely, suction of 25 L/min caused a marked increase in air content at carbon dioxide flows of both 5 and 10 L/min (P <.001). CONCLUSIONS: This study demonstrated that the most efficient deairing (<or =1% remaining air) in a cardiothoracic wound model was provided by a gas diffuser at a carbon dioxide flow of 10 L/min. A conventional 0.25-inch tube failed to do so (19.5%-51.7% remaining air). Additional suction deteriorated air displacement with the gas diffuser when suction exceeded carbon dioxide inflow.

Air Pressure↗

PubMed1999

Suction blister formation in skin after acute and repeated mast cell degranulation.

Mast cells and their proteases are thought to participate in the development of skin blisters in various pathological conditions. In this study, suction blistering was used as an experimental model to evaluate the significance of mast cells in blister formation after pre-treatment of normal skin with intradermal injections of 100 microg/ml compound 48/80 (a mast cell degranulator) or with 0.1% capsaicin cream. Tryptic and chymotryptic enzyme activities in blister fluids were measured with sensitive p-nitroanilide substrates. Repeated injections of compound 48/80 once a day on 3 or 5 consecutive days or capsaicin applications 3 times a day for 7 or 10 days were used to induce mast cell degranulation and inflammation in normal skin. Both treatments ultimately led to decreased wheal and erythema reactions before suction blistering, but neither treatment affected the size or formation rate of suction blisters. No suction blister fluids had detectable levels of chymotryptic activity, but blister fluids from bullous pemphigoid, herpes zoster and insect bullous eruption, used as the control, revealed clear chymotryptic activity. In addition, tryptic activity in suction blister fluids was not significantly altered after compound 48/80 and capsaicin pre-treatments. However, if the wheal reaction was induced immediately before suction blistering, a significantly increased rate in blister formation together with increased tryptic activity was found, but, unexpectedly, no chymotryptic activity could be detected in blister fluids. The results show that repeated mast cell degranulation in normal skin has no effect on the formation rate of suction blisters, which developed more rapidly on acutely whealing skin. This is probably due to skin oedema rather than mast cell proteases, since no chymotryptic activity was detected in suction blisters where tryptic activity exhibited high individual variation.

Adult↗

PubMed1996

Randomised evaluation of a prototype suction fetal scalp electrode.

OBJECTIVE: To compare the performance and acceptability of a prototype suction fetal scalp electrode with that of a double helix spiral electrode. SETTING: An urban academic hospital in Johannesburg, South Africa. DESIGN: Randomised, by means of sealed opaque envelopes opened consecutively. PARTICIPANTS: One hundred women in active labour with an indication for direct fetal heart rate monitoring. INTERVENTION: Application of a fetal scalp electrode to the presenting part. OUTCOME MEASURES: Performance of the electrodes with respect to application success, detachment, quality of the tracings, scalp trauma and women's preferences. RESULTS: Application of the suction electrode was unsuccessful in 15/50 (30%) compared to 1/50 (2%) with the spiral electrode. Detachment rates were similar. There were more tracings of average quality with the suction electrode (nine versus four). There were three instances of scalp bleeding at delivery with the spiral electrode. The suction electrode was preferred by more women and its application caused somewhat less discomfort. CONCLUSIONS: The lower rate of successful application with the suction electrode needs to be weighed against the advantage of avoiding fetal scalp penetration. In particular, women's concerns about pain or harm to the baby from needle electrodes, the theoretical risk of viral transmission, and the risk of serious scalp infection must be considered. These factors favour the use of a suction electrode when direct fetal heart rate monitoring is required. Needle electrodes should be considered when suction electrode application is unsuccessful. Correction of practical problems experienced with the prototype suction electrodes used in this study may result in improved success rates.

Adolescent↗

PubMed2000

Performance of a water suction system using hydrophilic fibrous cloth under low gravity and microgravity in parabolic flight.

For suction of water from a water supply vessel including both water and air under microgravity and g-jitter conditions, a water suction system using hydrophilic fibrous cloth was developed and its performance was evaluated at 0.01-0.02 g-realized for 20 s by parabolic flight in an aircraft. Vessels used for the experiment were glass flasks and had a suction port for suction filtration. A piece of hydrophilic fibrous cloth was arranged along the inner surface of the vessels and the end was fixed to the suction port of the vessels. In vessel without hydrophilic cloths and containing 220 mL of water, the water did not move more than 5 mm along the inner surface and did not reach the suction port under low gravity. When hydrophilic cloths were used, on the other hand, water gathered onto the cloth surface, moved up along the cloth and reached the suction port under low gravity. The amount of water sucked from vessels varied with the amount of water in the vessel and the sectional area of hydrophilic cloths. When the vessels including both water and air were flown during parabolic flight (10(-4) g), water in the vessel moved along the cloth and a water film was formed on the cloth. These results indicated that it is possible to suck water using the fibrous cloth suction system under low gravity and microgravity conditions. Under low gravity conditions, it was difficult to suck water only. However, it is not necessary to separate water from air when the system is used for supplying water to plant root medium consisting of both liquid and gas phases.

Acceleration↗

PubMed1982

Clinical effects of closed suction drainage on wound healing in patients with head and neck cancer.

This study was undertaken to determine what optimal levels of suction pressure were necessary to provide good drainage volume and obliteration of any dead space and also to determine the prevalence of clotting and complications secondary to various levels of suction pressure. The patients were grouped by their degree of nutritional depletion, prior radiation exposure, the types of surgical procedures undergone, and the results of tests using four levels of suction pressure. Three of the suction pressure values were obtained with a wall suction and one was obtained using a portable closed system. All wall suction pressure levels were certainly comparable with the portable unit. However, the portable unit provided continuous suction pressure when the patients were ambulatory and was not associated with any statistically significant increase in wound complications or equipment failure.

Head and Neck Neoplasms↗

PubMed1986

Partially ventilated endotracheal suction. Use in newborns with respiratory distress syndrome.

Ventilator adapters that permit endotracheal suction without disconnection from mechanical ventilation may overcome several of the theoretical contributors to the hypoxia and bradycardia associated with neonatal endotracheal suction. Such an adapter allows for partially ventilated endotracheal suction (PVETS) as opposed to traditional, nonventilated endotracheal suction. To test the clinical value of PVETS using an endhole adapter, changes in transcutaneous partial pressure of oxygen and heart rate were compared during paired PVETS and nonventilated endotracheal suction events on 32 occasions in 11 premature neonates with respiratory distress syndrome. Partially ventilated endotracheal suction was associated with a significant decrease in the incidence and severity of hypoxic events. Partially ventilated endotracheal suction, however, did not affect the incidence of bradycardic events; PVETS had a small but statistically significant effect on reducing the severity of bradycardia. No clear relationship between bradycardic and hypoxic events was evident.

Bradycardia↗