Document Detail


Open and closed-circuit endotracheal suctioning in acute lung injury: efficiency and effects on gas exchange.
MedLine Citation:
PMID:  16394688     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Closed-circuit endotracheal suctioning (CES) is advocated for preventing hypoxemia caused by the loss of lung volume resulting from open endotracheal suctioning (OES). However, the efficiency of CES and OES on tracheal secretion removal has never been compared in patients with acute lung injury. The authors designed a two-part study aimed at comparing gas exchange and efficiency between OES and CES performed at two levels of negative pressure. METHODS: Among 18 patients with acute lung injury, 9 underwent CES and OES at 3-h intervals in a random order using a negative pressure of -200 mmHg. Nine other patients underwent CES twice using two levels of negative pressure (-200 and -400 mmHg) applied in a random order. After each CES, a recruitment maneuver was performed using 20 consecutive hyperinflations. Tracheal aspirates were weighed after each suctioning procedure. Arterial blood gases were continuously recorded using an intravascular sensor. RESULTS: Open endotracheal suctioning induced a significant 18% decrease in arterial oxygen tension (Pa(O2)) (range, +13 to -71%) and an 8% increase in arterial carbon dioxide tension (Pa(CO2)) (range, -2 to +16%) that persisted 15 min after the end of the procedure. CES using -200 cm H2O did not change Pa(O2), but tracheal aspirate mass was lower compared with OES (0.6 +/- 1.0 vs. 3.2 +/- 5.1 g; P = 0.03). Increasing negative pressure to -400 cm H2O during CES did not change Pa(O2) but increased the tracheal aspirate mass (1.7 +/- 1.6 vs. 1.0 +/- 1.3 g; P = 0.02). CONCLUSIONS: Closed-circuit endotracheal suctioning followed by a recruitment maneuver prevents hypoxemia resulting from OES but decreases secretion removal. Increasing suctioning pressure enhances suctioning efficiency without impairing gas exchange.
Authors:
Sigismond Lasocki; Qin Lu; Alfonso Sartorius; Dominique Fouillat; Francis Remerand; Jean-Jacques Rouby
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  104     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2006-01-05     Completed Date:  2006-03-06     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  39-47     Citation Subset:  AIM; IM    
Affiliation:
Surgical Intensive Care Unit, Department of Anesthesiology, Bichat-Claude Bernard Hospital, University of Paris VII, Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Air Pressure
Blood Gas Analysis
Carbon Dioxide / blood
Female
Humans
Intubation, Intratracheal*
Lung / physiology
Lung Injury*
Male
Middle Aged
Oxygen / blood
Pulmonary Gas Exchange / physiology
Respiration, Artificial
Suction*
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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