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http://dx.doi.org/10.4040/jkan.2014.44.2.149

Effects of Open or Closed Suctioning on Lung Dynamics and Hypoxemia in Mechanically Ventilated Patients  

Lee, Eun Young (Youngnam Medical Center)
Kim, Su Hyun (College of Nursing, Kyungpook National University)
Publication Information
Journal of Korean Academy of Nursing / v.44, no.2, 2014 , pp. 149-158 More about this Journal
Abstract
Purpose: This study was conducted to compare effects of open and closed suctioning methods on lung dynamics (dynamic compliance, tidal volume, and airway resistance) and hypoxemia (oxygen saturation and heart rate) in mechanically ventilated patients. Methods: This study was a cross-over repeated design. Participants were 21 adult patients being treated with endotracheal intubation using a pressure-controlled ventilator below Fraction of Inspired Oxygen ($FiO_2$) 60% and PEEP $8cmH_2O$. Data were collected at baseline and 1, 2, 3, 4, 5, and 10 minutes after suctioning. Data were analyzed using two-factor ANOVA with repeated measures on time and suctioning type. Results: Effects of the interaction between suction type and time were significant for oxygen saturation and heart rate but not significant for dynamic compliance, tidal volume, or airway resistance. Prior to performance of suctioning, tidal volume and oxygen saturation were significantly lower, but airway pressure and heart rate were significantly higher using the closed suctioning method as compared with the open suctioning method. Conclusion: For patients on ventilator therapy below $FiO_2$ 60% and PEEP $8cmH_2O$, open suctioning performed after delivery of 100% $FiO_2$ using a mechanical ventilator may not have as much negative impact on lung dynamics and hypoxemia as closed suctioning.
Keywords
Airway resistance; Anoxia; Suction; Lung compliances;
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1 Fernández MD, Piacentini E, Blanch L, Fernández R. Changes in lung volume with three systems of endotracheal suctioning with and without pre-oxygenation in patients with mild-to-moderate lung failure. Intensive Care Medicine. 2004;30(12):2210-2215. http://dx.doi.org/10.1007/s00134-004-2458-3   DOI
2 Kim MS, Ahn YM, Park IO, Choi SJ, Yoo MY. The effects of open endotracheal suctioning (ETS) and close ETS on oxygen saturation and heart rate in premature infants with respiratory distress syndrome. Journal of Korean Academy of Nursing. 1998;28(3):529-539.   DOI
3 Almgren B, Wickerts CJ, Heinonen E, Hogman M. Side effects of endotracheal suction in pressure- and volume-controlled ventilation. Chest. 2004;125(3):1077-1080.   DOI   ScienceOn
4 Morrow B, Futter M, Argent A. Effect of endotracheal suction on lung dynamics in mechanically-ventilated paediatric patients. The Australian Journal of Physiotherapy. 2006;52(2):121-126.   DOI   ScienceOn
5 Kim DS. Clinical respiratory physiology. Seoul: Korea Medical Book Publisher; 1997.
6 Maggiore SM, Lellouche F, Pigeot J, Taille S, Deye N, Durrmeyer X, et al. Prevention of endotracheal suctioning-induced alveolar derecruitment in acute lung injury. American Journal of Respiratory and Critical Care Medicine. 2003;167(9):1215-1224. http://dx.doi.org/10.1164/rccm.200203-195OC   DOI   ScienceOn
7 Lindgren S, Almgren B, Högman M, Lethvall S, Houltz E, Lundin S, et al. Effectiveness and side effects of closed and open suctioning: An experimental evaluation. Intensive Care Medicine. 2004;30(8):1630- 1637. http://dx.doi.org/10.1007/s00134-003-2153-9
8 Campbell RS, Davis BR. Pressure-controlled versus volume-controlled ventilation: Does it matter? Respiratory Care. 2002;47(4):416-424.
9 Jun JH. New modes of mechanical ventilation. The Journal of Korean Association for Respiratory Care. 2010;7(1):43-50.
10 Weitl J, Bettstetter H. Indications for the use of closed endotracheal suction. Artificial respiration with high positive end-expiratory pressure. Der Anaesthesist. 1994;43(6):359-363.   DOI
11 Drägerwerk AG & Co. KGaA. Evita 4 edition: Excellent performance and reliability. Lubeck, DE: Author; 2010.
12 Koninklijke Philips Electronics N.V. Intellivue patient monitor MP20: Patient monitoring. Amsterdam, NL: Author; 2003.
13 Marino PL. The ICU book. 3rd ed. Department of Anesthesiology and Pain Medicine Yonsei University College of Medicine, translator. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.
14 Wellek S, Blettner M. On the proper use of the crossover design in clinical trials: Part 18 of a series on evaluation of scientific publications. Deutsches Arzteblatt International. 2012;109(15):276-281. http://dx.doi.org/10.3238/arztebl.2012.0276
15 Tabachnick BG, Fidell LS. Profile analysis of repeated measures. In: Tabachnick BG, editor. Using multivariate statistics. New York, NY: Harper Collins Publishers Inc.; 1989. p. 437-505.
16 Seymour CW, Cross BJ, Cooke CR, Gallop RL, Fuchs BD. Physiologic impact of closed-system endotracheal suctioning in spontaneously breathing patients receiving mechanical ventilation. Respiratory Care. 2009;54(3):367-374.
17 Vitaltec Corporation. Vital-CathTM closed suction systems.[Internet] Taichung, Taiwan: Author 2013 [cited 2013 January 3]. Available from: http://www.vitaltec.com.tw/products.php?ProType=About&ProID=1.
18 Oh H, Seo W. A meta-analysis of the effects of various interventions in preventing endotracheal suction-induced hypoxemia. Journal of Clinical Nursing. 2003;12(6):912-924.   DOI   ScienceOn
19 Ahn YM. Concept analysis of endotracheal suctioning (ETS). Journal of Korean Academy of Nursing. 2005;35(2):292-302.   DOI
20 Rolls K, Smith K, Jones P, Tuipulotu M, Butcher R, Kent B, et al. Suctioning an adult with a tracheal tube. Sydney, AU: NSW Health Statewide Guidelines for Intensive Care; 2007.
21 Seo MS. A comparison of the open versus closed-system of suctioning in oxygen: In oxygen saturation, vital signs and nursing time [master's thesis]. Seoul: Chung-Ang University; 2006.
22 Clochesy JM, Breu C, Cardin S, Whittaker AA, Rudy EB. Critical care nursing. 2nd ed. Philadelphia, PA: W. B. Saunders Company; 1996.
23 Lee ES, Kim SH, Kim JS. Effects of a closed endotracheal suction system on oxygen saturation, ventilator-associated pneumonia, and nursing efficacy. Journal of Korean Academy of Nursing. 2004;34(7):1315-1325.   DOI
24 Lasocki S, Lu Q, Sartorius A, Fouillat D, Remerand F, Rouby JJ. Open and closed-circuit endotracheal suctioning in acute lung injury: Efficiency and effects on gas exchange. Anesthesiology. 2006;104(1):39-47.   DOI   ScienceOn
25 Heinze H, Sedemund-Adib B, Heringlake M, Gosch UW, Eichler W. Functional residual capacity changes after different endotracheal suctioning methods. Anesthesia and Analgesia. 2008;107(3):941-944. http://dx.doi.org/10.1213/ane.0b013e3181804a5d   DOI   ScienceOn
26 American Association for Respiratory Care. AARC clinical practice guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respiratory Care. 2010;55(6):758-764.
27 Stenqvist O, Lindgren S, Kárason S, Söndergaard S, Lundin S. Warning! Suctioning. A lung model evaluation of closed suctioning systems. Acta Anaesthesiologica Scandinavica. 2001;45(2):167-172.   DOI   ScienceOn
28 Cereda M, Villa F, Colombo E, Greco G, Nacoti M, Pesenti A. Closed system endotracheal suctioning maintains lung volume during volume- controlled mechanical ventilation. Intensive Care Medicine. 2001; 27(4):648-654.   DOI   ScienceOn
29 Cho YA. Effect on oxygen saturation, heart rate, mean arterial pressure as type of endotracheal suctioning system to patients are ventilated in intensive care unit [master's thesis]. Seoul: Yonsei University; 2007.