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Intensive Care Med. 2004 Dec;30(12):2210-5. Epub 2004 Oct 12.

Changes in lung volume with three systems of endotracheal suctioning with and without pre-oxygenation in patients with mild-to-moderate lung failure.

Author information

1
Critical Care Center, Hospital de Sabadell, Parc Tauli s/n, 08208 Sabadell, Spain. rfernandez@cspt.es

Abstract

OBJECTIVE:

To compare changes in lung volume, oxygenation, airway pressure, and hemodynamic effects induced by suctioning with three systems in critically ill patients with mild-to-moderate lung disease, and also to evaluate the effects of hyperoxygenation applied prior to the maneuver as suggested by some guidelines.

DESIGN:

Prospective crossover study.

SETTING:

General intensive care department of a university-affiliated hospital.

PATIENTS:

Ten mechanically ventilated patients with mild-to-moderate acute respiratory failure.

INTERVENTIONS:

Patients were ventilated in volume control mode with a mean tidal volume of 490+/-88 ml, PEEP 7+/-4 cmH2O and FiO(2) 0.36+/-0.05. Suctioning was performed sequentially with a quasi-closed system, with an open system 10 min later, and finally with a closed system. Thereafter, pure oxygen was applied for 2 min and the whole suctioning sequence was repeated in reverse order.

MEASUREMENTS AND MAIN RESULTS:

Patients' mean PaO(2)/FiO(2) ratio was 273+/-28 mmHg. The reductions in lung volume during suctioning were similar with the quasi-closed (386+/-124 ml) and closed system (497+/-338 ml), but significantly higher with the open system (1281+/-656 ml, P=0.022). We found no significant hemodynamic adverse effects, and no significant SpO(2) reductions with all the studied suctioning techniques. Pre-oxygenation with pure oxygen did not induce additive effects in lung volume changes. With and without pre-oxygenation, lung volume returned to baseline in every patient within 10 min.

CONCLUSIONS:

Suctioning with closed and quasi-closed systems reduces the substantial losses in lung volume observed with the open system. Nevertheless, in patients without severe lung disease these changes were transient and rapidly reversible.

PMID:
15480564
DOI:
10.1007/s00134-004-2458-3
[Indexed for MEDLINE]

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