Mechanically Ventilated Newborns: A Comparison of Two Airway Suctioning Regimens 1228

Abstract

Tracheal suctioning (TS) although clinically necessary may cause hypoxemia, bradycardia, bacteremia and airway colonization. We hypothesize that some reduction of TS frequency will not adversely affect newborn care. In our NICU, TS was done q4h, but since in August 1997 the frequency was changed to q8h or as needed, a comparison of these two regimens was undertaken. TS (2 passes) was preceded by the instillation of 0.2 ml saline. Consistency, amount and color of secretions was documented. Data from 24 (q4h) and 24 (q8h) infants(bwgt. ≤1500g) on conventional ventilation for ≥7 days were analyzed. Variables studied included: reintubations (RTUB), postural drainages (PD), the incidence of bloodtinged secretions and airway colonization with Gram Positive Cocci (GPC) or Gram Negative Bacilli (GNB). Demographic and perinatal factors among the groups were similar. Infants in the q4h group (bwgt. 900g, 27w GA, 23 survivors) were comparable to those of the q8h group (bwgt. 952g, 27w GA, 23 survivors). Average number of TS/pt/d was 6 and 4.6 for q4h and q8h groups, respectively. Similar differences in TS frequency were noted at 7, 14 and 21days (p<0.01). Two pts. in the q8h group experienced nosocomial bloodstream infection (1 GPC, 1 GNB) unrelated to airway colonization. During hospitalization, newborns from both groups were RTUB on average 2.6 times, while 9 pts. (q4h) and 10 pts. (q8h) needed PD due to either atelectasis(often related to endotracheal tube malposition) or changes in quality/quantity of airway secretions. Blood-tinged secretions but not frank hemorrhage were noted during routine TS in 6 pts. (4 from q4h) and following RTUB in another 6 (5 from q8h). Eighteen pts. from each group were ventilated for at least 14 days. All but one had GPC (S.hemolyticus and/or S.epidermidis) and 22 of the 36 (q4h/q8h combined pts.) had GNB colonization. Equally distributed between the groups were:P.aeruginosa (7), H.influenzae (1), A.baumannii(2), K.pneumoniae (7), E.cloacae (1) and E.coli(4) isolates. Conclusion: A significant reduction in TS can be accomplished without affecting neonatal mortality, number of RTUB, need for PD, and timing and type of airway colonization. Significant cost benefits may be anticipated when comparable changes in the frequency of tracheal suctioning are implemented.