Abstract
IntroductionLung collapse is a contributory factor in the hypoxaemia that is observed after open endotracheal suctioning (ETS) in patients with acute lung injury and acute respiratory distress syndrome. Lung recruitment (LR) manoeuvres may be effective in rapidly regaining lung volume and improving oxygenation after ETS.Materials and methodA prospective, randomized, controlled study was conducted in a 15-bed general intensive care unit at a university hospital. Eight consecutive mechanically ventilated patients with acute lung injury or acute respiratory distress syndrome were included. One of two suctioning procedures was performed in each patient. In the first procedure, ETS was performed followed by LR manoeuvre and reconnection to the ventilator with positive end-expiratory pressure set at 1 cmH2O above the lower inflexion point, and after 60 min another ETS (but without LR manoeuvre) was performed followed by reconnection to the ventilator with similar positive end-expiratory pressure; the second procedure was the same as the first but conducted in reverse order. Before (baseline) and over 25 min following each ETS procedure, partial arterial oxygen tension (PaO2) and end-expiratory lung volume were measured.ResultsAfter ETS, PaO2 decreased by 4.3(0.9–9.7)kPa (median and range; P < 0.005). After LR manoeuvre, PaO2 recovered to baseline. Without LR manoeuvre, PaO2 was reduced (P = 0.05) until 7 min after ETS. With LR manoeuvre end-expiratory lung volume was unchanged after ETS, whereas without LR manoeuvre end-expiratory lung volume was still reduced (approximately 10%) at 5 and 15 min after ETS (P = 0.01).DiscussionA LR manoeuvre immediately following ETS was, as an adjunct to positive end-expiratory pressure, effective in rapidly counteracting the deterioration in PaO2 and lung volume caused by open ETS in ventilator-treated patients with acute lung injury or acute respiratory distress syndrome.
Highlights
Lung collapse is a contributory factor in the hypoxaemia that is observed after open endotracheal suctioning (ETS) in patients with acute lung injury and acute respiratory distress syndrome
Endotracheal suctioning (ETS), which is a common procedure in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), abolishes the positive airway pressure and even may generate negative pressure, promoting de-recruitment and hypoxaemia [2]
Pesenti and coworkers [10] found no reduction in end-expiratory lung volume (EELV) or arterial oxygen saturation in patients with ALI and ARDS after suctioning with such a system
Summary
After discontinuation of positive end-expiratory pressure (PEEP), lung collapse occurs rapidly in ventilator-treated patients with acute respiratory distress syndrome (ARDS) [1]. The most common method used to mitigate the reduction in oxygenation induced by suctioning is to increase the fractional inspired oxygen (FiO2) [3,4,5] This strategy is often effective in patients with less severe lung diseases, but is less efficacious in patients with ARDS with high shunt fractions [6]. Brochard and coworkers [13] showed that lung volume and arterial oxygenation could be maintained during open suctioning by using constant flow insufflation This method appears to be effective but necessitates use of a special endotracheal tube.
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