Endotracheal Suctioning Research Articles

Evaluation of prevention of ventilator-associated infections in four Australian intensive care units.

Effective approaches to practice improvement require development of tailored interventions in collaboration with knowledge users. To explore critical care nurses' knowledge and adherence to best practice guidelines for management of patients with an artificial airway to minimise development of ventilator-associated pneumonia. A cross-sectional study was undertaken across four intensive care units that involved three phases: (1) survey of critical care nurses regarding their current practice; (2) observation of respiratory care delivery; and (3) chart audit. Key care processes evaluated were: (1) technique and adherence to standard precautions when performing endotracheal suction, cuff pressure checks and extubation; and (2) frequency of endotracheal suctioning and mouth care. Observational and chart audit data on the provision and documentation of respiratory care were collected for 36 nurse/patient dyads. Forty-six nurses were surveyed and the majority responded that endotracheal suctioning and mouth care should be performed 'as required' or every 2 hours (h). During observations of practice, no patient received mouth care every 2 h, nor had documentation of such. Inconsistent adherence to standard precautions and hand hygiene during respiratory care provision was observed. Chart audit indicated that nurses varied in the frequency of suctioning consistent with documented clinical assessment findings. Although nurses had good knowledge for the management of artificial airways, this was not consistently translated into practice. Gaps were identified in relation to respiratory related infection prevention, the prevention of micro-aspiration of oropharyngeal secretions and in the provision of mouth care.

Exploration of the Nociception Level (NOL™) Index for Pain Assessment during Endotracheal Suctioning in Mechanically Ventilated Patients in the Intensive Care Unit: An Observational and Feasibility Study

BackgroundMany patients in the intensive care unit (ICU) suffer from pain and are non-communicative. Therefore, alternative pain measures are necessary. Although behavioral pain measures are available, physiological measures are lacking. The Nociception Level index (NOL™) provides a value from combination of multiple physiological parameters to measure pain and its use in the ICU is new. AimTo explore the use of a multiple physiological parameter measure for pain assessment, the NOL™ index, in mechanically ventilated patients able to self-report pain in the ICU. MethodsA prospective cohort study was performed. Data were collected before, during, and 15 minutes after a non-nociceptive procedure (noninvasive blood pressure using cuff inflation) and a nociceptive procedure (endotracheal suctioning). NOL index, 0 to 10 pain intensity, and Critical-Care Pain Observation Tool (CPOT) scores were also obtained. Data were analyzed using Friedman and Mann-Whitney tests. Feasibility of study procedures was described. ResultsOut of 28 patients who consented, 17 remained eligible and data were analyzed for 15. Technical issues prevented obtaining a NOL signal in 2 patients. NOL values were higher during endotracheal suctioning (median = 41.6) compared with before (median = 11.2) and after the procedure (median = 11.8) and compared with cuff inflation (median = 15.1; Friedman test, p < .001). NOL values were associated with pain intensity and CPOT scores (Mann-Whitney tests, p < .05). ConclusionsThe study procedures with the NOL were found feasible; NOL values could discriminate between nociceptive and non-nociceptive procedures, and values were associated with reference pain measures. Further NOL testing is required in other ICU patient groups and procedures.

Measurement of Knowledge and Performance of Pediatric ICU Nurses about Endotracheal Suctioning

Introduction: Safe and aseptic endotracheal suctioning has been a major health challenge in ICU setting, Endotracheal suction is a procedure to insert a suction catheter into the endotracheal tube to remove the secretion. Where endotracheal tube suctioning is essential for a patient with mechanical ventilation to keep their airway clean and infection free, it has also been associated with some adverse effect like hypoxia and ventilator associated pneumonia.in this regard ICU nurses knowledge and competences should be according to set criteria of ETT suctioning procedure. Methods: Target population of this study was ICU nurses of one of the children hospital, Lahore. Sample size was 98. Results: The findings of this research was beyond our expectation as nurses practices was good and their knowledge was fair. Conclusions: This study gives an overview of the ICU nurses knowledge and performance related to ETT suctioning and demonstrates that intensive care nurses' performance regarding endotracheal suctioning is good enough despite fair knowledge. With concerning to these finding there is a need for educational courses, especially theoretical education and motivational session to follow the standard protocol for ETT suction. Keywords: Pediatric, ICU, Knowledge, Performance DOI: 10.7176/JHMN/73-09 Publication date: April 30 th 2020

Bacterial Contamination from Intraoperative Endotracheal Suctioning in Songklanagarind Hospital

Bacterial Contamination from Intraoperative Endotracheal Suctioning in Songklanagarind Hospital

Effects of Manual Rib Cage Compressions on Mucus Clearance in Mechanically Ventilated Pigs.

Manual rib cage compression is a chest physiotherapy technique routinely used in clinical practice. However, scientific evidence remains scarce on the effects of manual rib cage compression on airway clearance and oxygenation in mechanically ventilated patients. Anesthetized pigs were intubated via the trachea and mechanically ventilated. To create atelectasis, artificial mucus was infused into the airway. Each pig was randomly assigned to 1 of 2 groups: closed suctioning alone (control group, 7 pigs), or manual rib cage compression combined with closed suctioning (manual rib cage compression group, 8 pigs). Hard and brief rib cage compression synchronized with early expiratory phase was tested. Mucus clearance and oxygenation were assessed after the intervention. Sequential changes of hemodynamics were assessed after the intervention. During hard manual rib cage compression, the mean ± SD peak expiratory flow increased to 44 ± 7 L/min compared with 31 ± 7 L/min without treatment (P < .001). Manual rib cage compression combined with endotracheal suctioning increased mucus clearance compared with closed suctioning alone (mucus amounts, 5.5 [3.4-9.4] g vs 0.7 [0.5-2.0] g; P = .004); however, it did not improve gas exchange and radiologic findings. There were no significant differences in hemodynamic variables between the 2 groups. Our findings indicated that hard and brief manual rib cage compression combined with closed suctioning was safe and led to improvement of mucus clearance; however, no effectiveness was confirmed with regard to oxygenation and ventilation.

EFFECT OF SIMULATION-BASED SUCTION EDUCATION ON THE KNOWLEDGE AND PERFORMANCE OF PEDIATRIC INTENSIVE CARE UNIT NURSES

Introduction: Nursing interventions have a direct effect on the health and clinical improvement of children. Therefore, nurses should be aware of the risks of endotracheal suctioning and receive continuous education in this field. The present study aimed to investigate the effect of simulation-based suction education on knowledge and performance of pediatric intensive care unit nurses. Methods: In a quasi-experimental study between 2019 and 2020, 33 nurses working in pediatric and neonatal intensive care units were selected as availability samples. First, nurses' performance in suctioning was evaluated by a standard checklist, then, suction education was performed by simulation method. Six months after the education, nurses' performance in standard suctioning was re-evaluated and analyzed by SPSS 22 software. Results: The mean score of knowledge and performance after the education (43.99 ± 6.03) was significantly different from before the education (5.58 ± 5.3) (P

Endotracheal Suctioning: Effectiveness of Structured Training Program in Enhancing Performance Knowledge of Intensive Care Unit Nurses

Endotracheal Suctioning: Effectiveness of Structured Training Program in Enhancing Performance Knowledge of Intensive Care Unit Nurses

The Effects of Open and Closed Suction Methods on Occurrence of Ventilator Associated Pneumonia; a Comparative Study.

Endotracheal suctioning is a method commonly used to clean airway secretions in patients under mechanical ventilation (MV). This study aimed to compare the effects of open and closed suction methods on the occurrence of ventilator associated pneumonia (VAP). This comparative study was carried out on adult intensive care unit (ICU) patients in need of MV for more than 48 hours, from October 2018 to January 2019. Patients were randomly allocated to either closed tracheal suction system (CTSS) group or open tracheal suction system (OTSS) group. Patients were monitored for developing VAP within 72 hours of intubation and the findings were compared between groups. 120 cases with the mean age of 57.91±19.9 years were randomly divided into two groups (56.7% male). The two groups were similar regarding age (p = 0.492) and sex (p = 0.713) distribution. 22 (18.3%) cases developed VAP (12 (20%) in OSST group and 10 (16.7%) in CSST; p = 0.637). The most prevalent bacterial causes of VAP were Acinetobacter_Baumannii (72.7%), Klebsiella pneumoniae (18.2%), and Methicillin-Resistant Staphylococcus aureus (9.1%), respectively. There was not any significant difference between groups regarding the mean duration of remaining under MV (p = 0.623), mean duration of hospitalization (p = 0.219), frequency of VAP (p = 0.637), and mortality (p = 0.99). It seems that type of endotracheal suction system (OSST vs. CSST) had no effect on occurrence of VAP and other outcomes such as duration of need for MV and ICU stay as well as mortality.

The effect of performance feedback and educational video on endotracheal-suctioning practices of critical care nurses.

INTRODUCTION:Majority of critical care nurses do not have desirable skills in performing endotracheal tube suctioning (ETS) despite related training taught in the curricula. This study aimed to investigate and compare the effect of education through video and performance feedback (PF) on nurses' skills in performing ETS.METHODS:This was a quasi-experimental study. The sample size comprised of all nurses (n = 49) working in the intensive care unit of one of the educational hospital located in one of the western cities of Iran. Nurses were assigned to either one of educational video (EV) and PF groups. Data were collected using a 25-item structured best practices information sheet. Data were analyzed using SPSS software version 20 (SPSS Inc., Chicago, IL, USA).RESULTS:After the interventions, no significant difference was found in the total mean score of nurses' practice in ETS between those who received education through EV and those who received through PF (16.3 vs. 15.1) (P > 0.05). Before and after the intervention, a significant improvement was observed in the total mean score and other dimensions of nurses' practice in endotracheal suctioning (P < 0.0001).CONCLUSIONS:The results showed that both of methods through feedback and EV are useful in improving nurses' ETS practice. However, further studies are required to examine the effects of such interventions in the long term.

Feasibility of Pupillometry-Based Indices to Assess Nociception in Sedated Critically Ill Patients.

To the Editor We have read with interest the article by Vinclair et al.1 We appreciate the research study done by the esteemed authors, as we also use pupillometer in our clinical practice. Patients on treatment with drugs that were known to alter pupil reflex dilation measurements were excluded from the study. It was noted that for sedation, the patients received continuous infusions of midazolam or propofol, sufentanil, and ketamine at the discretion of the physician in charge.1 Also, the doses of sufentanil were higher in the brain-injured group than in the non–brain-injured group. Rouche et al2 studied the effects of depth of sedation on pupillometry indices in mechanically ventilated patients. They compared the maximum contraction velocity of the pupil (Vmax) and variation in pupil diameter (PD) among 3 groups of patients based on the levels of sedation by evaluating the of bispectral index (BIS). The groups were classified as patients under heavy sedation (<40), acceptable sedation (40–60), and light sedation (>60) based on BIS values. There was a significant difference in Vmax between the heavily sedated and the acceptable groups (P < .0001) and also a significant difference in the variation of PD (P < .0001) between the groups.2 Similarly, there was a significant difference in Vmax (P < .0001) and variation in PD (P < .0001) between heavy sedation and light sedation groups.2 Gaillard et al3 evaluated the pupillary dilation reflex (PDR), to a noxious stimulus, for predicting analgesic level before endotracheal suctioning of mechanically ventilated patients under a deep level of sedation by applying tetanic stimulations of 10, 20, 40, and 60 mA.3 There was no significant difference in the area under the receiver operating characteristic (ROC) curves between different intensity levels. It was also noted that the PDR never exceeded 0.6 even with the highest stimulation.3 In the present study, the authors have not mentioned the level of sedation of the patients, and this could have contributed to possible bias in their study. In the present study, the authors found that pupillary pain index measurements during tetanic stimulation positively correlated with behavioral pain scale responses to endotracheal suctioning. However, the authors did not analyze the correlation with the behavioral pain scale during tetanic stimulation. Tetanic stimulation and endotracheal suctioning are 2 different noxious stimuli as one is a central stimulus carried by the cranial nerves, whereas the latter is a peripheral stimulation via the spinal cord. Though the authors have excluded patients with bilateral mydriasis, which happens at a later stage of brain herniation, they did not exclude patients with other pupillary abnormalities. Patients at early stages of uncal herniation will have unilateral mydriasis and patients with mild brain injury can present with sluggish pupillary responses.4 Similarly, the patients with brainstem injury could present with varied pupillary responses, the most notable being the pinpoint pupils encountered in pontine injury.4 We want to point out that there had been no mention of these clinical presentations and the assessment of pupillometry in such patients could result in erroneous findings. Aishvarya Shree Nedunchezhian, MDNeeraja Ajayan, MDAjay Prasad Hrishi, MD, DNB, DMDivision of NeuroanesthesiaDepartment of AnaesthesiologySree Chitra Tirunal Institute for Medical SciencesThiruvananthapuram, Kerala, India[email protected]

In Response.

We thank Hrishi and colleagues1 for their comments on our recently published study.2 They give us the opportunity to clarify some points related to the use of quantitative pupillometry in critically ill patients. Two pupillary reflexes can be measured using portable infrared pupillometry: pupillary light reflex (PLR) in response to light stimulus and pupil reflex dilation (PRD) in response to noxious stimulus. By providing information on the brainstem integrity through the second and third cranial nerves, there is a growing interest in using quantitative PLR to estimate prognosis after cardiac arrest and traumatic brain injury. Contrary to the widely held opinion, PLR amplitude is relatively resistant to opioids, propofol, volatile agents, and neuromuscular blocking agents.3 We did not use PLR to assess nociception in our study. On the other way, PRD is an evoked reflex mediated through the ophthalmic nerve to detect painful reactions in nonverbal patients. It is largely admitted that opioids depress PRD in a dose-related fashion. Because γ-aminobutyric acid type A (GABAa) receptors might be involved in generating PRD,3 GABAa agonists such as propofol and midazolam could interfere with PRD measurements. Given that critically ill patients usually receive both opioids and sedatives, monitoring analgesia using PRD implies necessarily considering the level of sedation. In our study, all patients were kept sedated at Richmond Agitation Sedation Scale (RASS) −5 to −4, as shown in Table 2. The choice of noxious stimulus is critical to appropriately assess nociception in nonverbal patients. Laryngoscopy, tracheal intubation, and surgical incision are stimuli of very different uncontrolled noxious intensities. Tetanic stimulation is a more predictable source of painful stimulus than these procedures. Nursing, as used in the referenced poster presentation,4 is a multifaceted procedure that cannot be standardized to assess nociception. Nursing has been never used to validate any pain instrument. The pupillary pain index (PPI) is an elegant approach to estimate nociception while avoiding unnecessary pain and poor tolerance with the application of predefined intensity of electric stimulation. The maximal 13% dilation threshold from baseline was chosen to prevent systemic reactions such as tachycardia and arterial hypertension during tetanic stimulus. Accordingly, we found no changes in these systemic parameters or in Behavioral Pain Scale (BPS) scores during tetanic stimulation. Assessing nociception in brain-injured patients implies the integrity of PRD reflex pathway. Otherwise, PRD measurements can be used as an indicator of peripheral nerve block efficacy or to detect hemispheric brain lesion in a sedated patient. In the present study, there was no evidence of focal neurological lesion according to the computed tomography (CT) scan and PLR measurements. In the rare case of asymmetric PRD response, the highest PPI was taken for the analysis to detect patients with true nociception during endotracheal suctioning. Marc Vinclair, MDClotilde Schilte, MDGilles Francony, MDJean-Francois Payen, MD, PhDDepartment of Anesthesia and Critical CareGrenoble Alpes University HospitalGrenoble, France[email protected]

Avoidance of endotracheal suction in elective post-operative cardiac surgical patients: A non-inferiority randomised controlled trial

Avoidance of endotracheal suction in elective post-operative cardiac surgical patients: A non-inferiority randomised controlled trial

Development of a tracheal model for an endotracheal suction simulator using augmented reality scene with haptics

Development of a tracheal model for an endotracheal suction simulator using augmented reality scene with haptics

Effects of Open and Closed Tracheal Suctioning on Pain in Mechanically Ventilated Patients.

Background:Painful care procedures are the most common cause of stress in patients admitted to Intensive Care Units (ICUs). Tracheal suctioning is the most painful experience for ICU patients. The present study was conducted to compare open and closed endotracheal suctioning in terms of their effect in pain in mechanically ventilated patients.Materials and Methods:The present clinical trial recruited 70 mechanically ventilated patients with tracheostomy in 2019. The eligible patients were randomly divided into open and closed suctioning groups. The pain was measured in the patients using the Critical Pain Observational Tool (CPOT) before and during suctioning as well as 10 and 30 min later. The data were analyzed using the repeated measures Analysis Of Variance (ANOVA), paired t-test, and Chi-squared test.Results:The pain score was significantly higher in the open suctioning group during (t = 2.59, p = 0.01) and 10 min after suctioning (t = 3.02, p = 0.004). No significant differences were observed in the pain score between the two groups 30 min after suctioning (t = 0.32, p = 0.75). The post hoc Least Significant Difference (LSD) test showed that the CPOT scores 10 min after suctioning was significantly higher than that before suctioning and significantly lower than that during suctioning (p = 0.001). The CPOT score 30 min after suctioning was also significantly lower than that 10 min after suctioning (p < 0.001).Conclusions:The present findings suggested a lower pain in the patients with closed suctioning compared to those with open suctioning.

Effects of Endotracheal Tube Fixation Methods on Hemodynamic Parameters During Endotracheal Suction

Effects of Endotracheal Tube Fixation Methods on Hemodynamic Parameters During Endotracheal Suction

Strategies for the Prevention of Ventilator-associated Pneumonia in the Intensive Care Units: A Review

Ventilator-Associated Pneumonia (VAP) accounts for 80-90% of hospital-acquired pneumonia cases in Intensive Care Units (ICUs). VAP occurs 48-72 hours after intubation, and is observed in 27-29% of patients with endotracheal tube, and its risk increases with the increase in the duration of mechanical ventilation. In this review study, papers published from 1996-2018 were used to investigate strategies for preventing VAP in ICU patients. For this purpose, English articles with full text available on ProQuest, SID, ScienceDirect, Google Scholar and Scopus databases were searched online using the keywords related to VAP and chest physiotherapy used in the title or abstract. A total of 50 articles (from 10 different countries) covering both qualitative and quantitative studies in Persian and English conducted the last 19 years (since 1999) were selected. Those which were not a review/research paper and their full text were unavailable were excluded from the review. Among nosocomial infections, VAP is the most common cause of death, and the leading cause of death in ICUs. Physical strategies with a significant effect on the reduction of VAP included: Orotracheal intubation, closed endotracheal suctioning, use of humidifier and moisturizer, and chest physiotherapy. Effective positional strategies were: the use of kinetic beds, semi-recumbent position (45 degrees), and prone position. Effective medication strategy is the use of topical and intravenous antibiotic prophylaxis.

Adverse events and practice variability associated with paediatric endotracheal suction: An observational study

ObjectiveThe objective of this study was to determine the incidence of endotracheal tube (ETT) suction–related adverse events (AEs) and to examine associations between AEs and patient and suction characteristics. Secondary objectives were to describe ETT suction practices in an Australian paediatric intensive care unit (PICU). MethodsA prospective, observational study was undertaken in a mixed cardiac and general PICU. Children were eligible for inclusion if they were intubated and mechanically ventilated. Data on patient and suction variables (indication for ETT suction, number of suction episodes per mechanical ventilation episode, indication for normal saline instillation [NSI] and NSI dose) including potential predictive variables (age, Paediatric Index of Mortality 3 [PIM3], NSI, positive end-expiratory pressure, and hyperoxygenation) were collected. The main outcome variable was a composite measure of any AE. Main resultsA total of 955 suction episodes were recorded in 100 children. AEs occurred in 211 (22%) ETT suctions. Suction-related AEs were not associated with age, diagnostic category, or index of mortality score. Desaturation was the most common AE (180 suctions; 19%), with 69% of desaturation events requiring clinician intervention. Univariate logistic regression showed the odds of desaturation decreased as the internal diameter of the ETT increased (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.37–0.95; p = 0.028). Multivariable modelling revealed NSI was significantly associated with an increased risk of desaturation (adjusted OR [aOR]: 3.23; 95% CI: 1.99–5.40; p < 0.001) and the occurrence of an AE (aOR: 2.76; 95% CI: 1.74–4.37; p < 0.001). Presuction increases in fraction of inspired oxygen (FiO2) was significantly associated with an increased risk of experiencing an AE (aOR: 2.0; 95% CI: 1.27–3.15; p = 0.003). ConclusionsETT suction–related AEs are common and associated with NSI and the requirement for pre-suction increases in FiO2. Clinical trial data are needed to identify high-risk patient groups and to develop interventions which optimise practice and reduce the occurrence of ETT suction–related AEs.

Endotracheal suctioning for prevention of meconium aspiration syndrome: a randomized controlled trial.

The current version of Neonatal Resuscitation Program no longer favors routine endotracheal suctioning (ETS) in non-vigorous newborns with meconium-stained amniotic fluid (MSAF) due to possibility of procedure-related harms and questionable benefits. However, it calls for additional research on this procedure to provide a definitive answer. The present study was conducted to evaluate the role of ETS in non-vigorous neonates of ≥ 34weeks' gestation born through MSAF on the incidence of meconium aspiration syndrome (MAS). In this open-label randomized controlled trial, 132 non-vigorous neonates with MSAF were randomized to receive ETS (n = 66) or no-ETS (n = 66) during delivery room resuscitation (DRR). Primary outcome variable was incidence of MAS. Secondary outcome variables were requirement of DRR, need of respiratory support, development of complications, duration of hospitalization, and mortality. Both the groups were comparable with respect to maternal and neonatal characteristics. Incidence of MAS was 21 (31.8%) and 15 (22.7%) cases in ETS and no-ETS groups, respectively (relative risk (RR), 1.400, 95% confidence interval (CI), 0.793-2.470). The two groups did not differ with regard to DRR, need for respiratory support, and development of complications. Nine (13.6%) neonates in ETS group, and 5 (7.5%) in no-ETS group died (p > 0.05). Median (interquartile range) duration of hospital stay was 54 (31-141)h and 44 (26-102)h in ETS and no-ETS groups, respectively (p > 0.05).Conclusions: Routine ETS at birth is not useful in preventing MAS in non-vigorous neonates of ≥ 34weeks' gestation born through MSAF.Trial registration: Clinical Trials Registry of India (CTRI/2015/04/008819).What is Known:• Routine endotracheal suctioning is of questionable benefit in non-vigorous newborns with meconium stained amniotic fluid and may have a possibility of procedure-related harms.What is New:• Routine endotracheal suctioning at birth is not useful in preventing meconium aspiration syndrome in non-vigorous newborns of ≥ 34 weeks' gestation born through meconium stained amniotic fluid.

Knowledge and Practices of Endotracheal Suctioning amongst Nursing Professionals: A Systematic Review.

ABSTRACTIntroductionVentilator-associated pneumonia, a common cause of mortality and morbidity, is commonly seen among patients with endotracheal intubation due to unsafe suctioning practices by health professionals.ObjectiveA systematic review was conducted to explore the gaps in the existing practices of nurses and thus proposing comprehensive guidelines for safe practice.Materials and methodsA two-phase strategy was adopted to identify the studies through a comprehensive electronic search in PubMed, Google Scholar, ProQuest, Ovid, and Helinet Summon by using predefined keywords within a year limit of 2002–2016. The quality of studies was reviewed using tools endorsed by Joanna Briggs Institute. This review was conducted according to the guidelines described in the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Qualitative data were described through the process of metasynthesis. Quantitative analysis was performed to combine the competent quantitative evidences to identify knowledge and practices of endotracheal suctioning (ETS).ResultsThirty studies had been subjected for metasynthesis, among which six provided relevant information for quantitative analysis. Quantitative analysis of the studies reported that only 36% of the nurses had assessed patients prior to suctioning and had knowledge about the size of the suction catheter while only 46% were aware of the appropriate suction pressure to be used for ETS. Handwashing compliance prior to suctioning was observed in only 62% of the nurses. It is reported that, despite the awareness on possible complications, nurses fail to adhere to the recommended practice guidelines.ConclusionThe current review would explore the best evidence-based practices (EBPs) among nurses related to ETS, which would ensure quality care to critically ill patients.How to cite this articlePinto HJ, D'silva F, Sanil TS. Knowledge and Practices of Endotracheal Suctioning amongst Nursing Professionals: A Systematic Review. Indian J Crit Care Med 2020;24(1):23–32.

Detection of intratracheal accumulation of thick secretions by using continuous monitoring of respiratory acoustic spectrum: a preliminary analysis.

The accumulation of tracheobronchial secretions may contribute to a deterioration in pulmonary function and its early detection is important. In this study, we analyzed the respiratory sound spectrum in patients with intratracheal secretion, and compared acoustic characteristics before and after therapeutic endotracheal suctioning. After review of anesthetic records of liver transplant recipients, we included recipients with identified intratracheal secretion during surgery. Intraoperative breath sounds recorded through esophageal stethoscope were sampled in 20s-period before and after suctioning of secretion and analyzed using fast Fourier transform. We also analyzed normal breath sounds from recipients without any respiratory problem as control group. The maximal power (dBmMax), total power from whole frequency range of 80-500Hz (Pt), total power of each frequency range (80-200Hz, P80-200; 200-300Hz, P200-300; 300-400Hz, P300-400; 400-500Hz, P400-500), and their ratio (P80-200/Pt, P200-300/Pt, P300-400/Pt, P400-500/Pt) were compared. Breath sounds were obtained from 20 recipients; 9 pairs of breath sound before and after suctioning of secretion and 11 normal breath sounds. Patients with intratracheal secretion showed significantly higher P80-200, P200-300, P300-400, P400-500 when compared to the those of normal control patients (P = 0.003, P = 0.002, and P = 0.009, respectively), while dBmMax did not differ. Elimination of secretions attenuated P80-200, P200-300, P300-400, and P400-500 by 22.4%, 25.7%, 48.5%, and 15.3%, respectively (P = 0.002, 0.024, 0.009, and 0.016, respectively). Identifying the presence of intratracheal secretions with power ratio at 80-200Hz and 300-400Hz showed the highest area under the curve of 0.955 in receiver operating characteristic curve analysis. We suggest that spectral analysis of breath sounds obtained from the esophageal stethoscope might be a useful non-invasive respiratory monitor for accumulation of intratracheal secretion. Further prospective studies to evaluate the utility of acoustic analysis in surgical patients are warranted.