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Abstract

Introduction: Endotracheal suctioning is associated with complications including bleeding, infection, hypoxemia, cardiovascular instability, and tracheal mucosal injury. A closed-suction catheter has some advantages, which include minimizing risk of hypoxemia and prevention of infected secretions during suctions. Recently, a closed-suction catheter with pressure valve (Acetrachcare, AceMedical Co., South Korea) was developed. We hypothesized that this new catheter might reduce tracheal mucosal injury compared with conventional closed-suction catheter (Trachcare, Kimberly-balla RD, USA). Methods: The prospective, randomized study included medical and surgical patients requiring mechanical ventilation for more than 48 hours. Patients were randomized into two groups; one group was suctioned with the conventional closed-suction catheter (CCC) and the other group with the closed-suction catheter with pressure valve (CCPV). In CCC group, the wall suction vacuum pressure was kept around 100 mmHg. In CCPV group, the level of pressure used to perform endotracheal suction was adjusted by intensivist according to sputum amount (small, moderate or large). Bronchoscopy was performed 48 hours later, and the severity of tracheal mucosal injury was graded from 0 to 4, as follows: 0 = normal; 1 = erythema or edema; 2 = erosion; 3 = hemorrhage; 4 = ulceration or necrosis. Results: A total of 63 patients (31 with CCPV and 32 with CCC) were included. There were no significant differences between groups about age, sex, diagnosis groups, sputum appearance, mortality, and Acute Physiology and Chronic Health Evaluation II score. No significant difference was found in hypoxemia, hypercapnia, maximal heart rate, arrhythmia, mean arterial pressure and elevated airway pressure during suctioning. On bronchoscopic evaluation, the usage of CCPV led to a significantly reduce tracheal mucosal injury (median tracheal mucosal injury grade 0 [IQR 0–1] vs 2 [IQR 1–2], p<0.05). However, there were no differences in nurse satisfaction, total number of suction for 24 hours, microbial growth and the prevalence of ventilator-associated pneumonia. Conclusions: We conclude that the novel closed-suction catheter with pressure valve may reduce tracheal mucosal injury compared to conventional catheter.