Document Detail

Increasing positive end expiratory pressure at extubation reduces subglottic secretion aspiration in a bench-top model.
MedLine Citation:
PMID:  20712671     Owner:  NLM     Status:  MEDLINE    
AIM: To estimate the ability of simulated tracheal suction, adjusting the positive end expiratory pressure (PEEP) settings on the ventilator or compressing a self-inflating bag to minimize aspiration during cuff deflation and extubation in a bench-top model.
BACKGROUND: During intubation, colonized secretions accumulate in the subglottic space above the endotracheal tube (ETT) cuff. Consequently, during cuff deflation and extubation, there is a risk of aspiration of the secretions. This may result in pneumonitis or pneumonia. There are a number of techniques used during cuff deflation and extubation to prevent secretion aspiration.
METHOD: A model trachea was intubated and the proximal end of the ETT was attached to a mechanical ventilator. Ten millilitres of water was placed above the inflated cuff and then nine test protocols were implemented in a random order to simulate tracheal suction, adjusting the PEEP settings on the ventilator or compressing a self-inflating bag. The volume of water 'aspirated' by the model was determined by weighing the apparatus pre- and post-extubation. Statistical analysis was performed using regression analysis and heteroscedastic t tests with a Bonferroni correction.
RESULTS: The level of PEEP was negatively correlated with the volume of fluid aspirated [co-efficient -0.24 (99% confidence interval -0.31 to -0.17), R(2) = 0.75]. Significantly less fluid was aspirated when a PEEP of 35 cmH(2)O was applied when compared with competing techniques.
DISCUSSION AND CONCLUSIONS: This study suggests that applying PEEP during cuff deflation and extubation is protective against aspiration. We conclude that unless there is a contraindication, the application of PEEP should be considered when extubating patients.
Jack Hodd; Alex Doyle; Joseph Carter; John Albarran; Peter Young
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Nursing in critical care     Volume:  15     ISSN:  1478-5153     ISO Abbreviation:  Nurs Crit Care     Publication Date:    2010 Sep-Oct
Date Detail:
Created Date:  2010-08-17     Completed Date:  2010-12-08     Revised Date:  2011-03-10    
Medline Journal Info:
Nlm Unique ID:  9808649     Medline TA:  Nurs Crit Care     Country:  England    
Other Details:
Languages:  eng     Pagination:  257-61     Citation Subset:  N    
Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital NHS Trust, Critical Care, King's Lynn, UK.
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MeSH Terms
Bodily Secretions*
Equipment Design
Intubation, Intratracheal*
Models, Anatomic
Pneumonia, Aspiration / prevention & control*
Positive-Pressure Respiration / adverse effects,  methods*
Trachea / injuries

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