| Increasing positive end expiratory pressure at extubation reduces subglottic secretion aspiration in a bench-top model. | |
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MedLine Citation:
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PMID: 20712671 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Jack Hodd; Alex Doyle; Joseph Carter; John Albarran; Peter Young |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Nursing in critical care Volume: 15 ISSN: 1478-5153 ISO Abbreviation: Nurs Crit Care Publication Date: 2010 Sep-Oct |
Date Detail:
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Created Date: 2010-08-17 Completed Date: 2010-12-08 Revised Date: 2011-03-10 |
Medline Journal Info:
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Nlm Unique ID: 9808649 Medline TA: Nurs Crit Care Country: England |
Other Details:
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Languages: eng Pagination: 257-61 Citation Subset: N |
Affiliation:
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Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital NHS Trust, Critical Care, King's Lynn, UK. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Bodily Secretions* Equipment Design Humans Intubation, Intratracheal* Models, Anatomic Pneumonia, Aspiration / prevention & control* Positive-Pressure Respiration / adverse effects, methods* Suction Trachea / injuries |
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