Aims: Our aim is to compare volume of suctioned secretion, respiratory mechanics, and hemodynamic parameters in intubated patients undergoing closed-system endotracheal suctioning alone (control group) versus closed-system tracheal suctioning with an expiratory pause (intervention group).
Settings And Design: Randomized crossover clinical trial.
Materials And Methods: Patients who had been on mechanical ventilation for more than 24 hours were randomly assigned to receive closed-system suctioning alone or closed-system suctioning with an expiratory pause on the ventilator. The following variables were evaluated: heart rate, respiratory rate, mean arterial pressure, peripheral arterial oxygen saturation, peak inspiratory pressure, mechanical ventilator circuit pressure during aspiration, exhaled tidal volume, dynamic compliance, resistance, and weight of suctioned secretion.
Statistical Analysis: Compared using the paired -test and general linear model analysis of variance for normally distributed variables (as confirmed by the Kolmogorov-Smirnov test). The Wilcoxon test was used for variables with a nonparametric distribution, while the Chi-square test and Fisher's exact test were used for categorical variables.
Results: The sample comprised 31 patients (mean age, 61.1 ± 18.2 years). The amount of secretion suctioned was significantly higher in the intervention group than in the control group (1.6 g vs 0.45 g; = 0.0001). There were no significant changes in hemodynamic parameters or respiratory mechanics when comparing pre- and postprocedure time points.
Conclusion: The combination of closed-system endotracheal suctioning and an expiratory pause significantly increased the amount of secretion suctioned compared to conventional suctioning without expiratory pause.
Key Messages: Combination of closed-system endotracheal suctioning and an expiratory pause significantly increased the amount of secretion suctioned.
How To Cite This Article: Martins LFG, Naue WS, Skueresky AS, Bianchi T, Dias AS, Forgiarini Junior LA. Effects of Combined Tracheal Suctioning and Expiratory Pause: A Crossover Randomized Clinical Trial. Indian J Crit Care Med 2019;23(10):454-457.
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http://dx.doi.org/10.5005/jp-journals-10071-23263 | DOI Listing |
J Hosp Infect
January 2025
Department of Energy and Refrigerating Air-conditioning Engineering, National Taipei University of Technology, Taipei, Taiwan.
Background: This study evaluated aerosol exposure during various respiratory activities (breathing, tachypnea, coughing, and oxygen therapy) in environments with directional air purifiers (DAPs), HEPA evacuators, and standard negative pressure (SNP) rooms to explore potential alternatives for addressing isolation room shortages.
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Respir Care
October 2024
Sorbonne Université, GRC 29, DMU DREAM, AP-HP, Hôpital Pitié-Salpetrière, Département d'Anesthésie-Réanimation, Paris, France.
Background: Inhaled sedation is increasing in ICUs, with active carbon filters (ACFs) commonly used for evacuating halogenated gases. However, the potential benefits of a waste anesthetic gas system (WAGS) similar to the ones used in operating rooms should be explored. To limit the suction over the flow sensor where the WAGS is connected on ICU ventilators, an anesthetic gas receiving system (AGRS) is required, constituting with the WAGS an active gas receiving and scavenging system (AGRSS).
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July 2024
Grup de Recerca en Malalt Crític (GMC), Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IRIS-CC), Vic, Spain.
Background: In standard weaning from mechanical ventilation, a successful spontaneous breathing test (SBT) consisting of 30 min 8 cmHO pressure-support ventilation (PSV8) without positive end-expiratory pressure (PEEP) is followed by extubation with continuous suctioning; however, these practices might promote derecruitment. Evidence supports the feasibility and safety of extubation without suctioning. Ultrasound can assess lung aeration and respiratory muscles.
View Article and Find Full Text PDFJ Aerosol Med Pulm Drug Deliv
June 2024
Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois, USA.
Some experts recommend specific ventilator settings during nebulization for mechanically ventilated patients, such as inspiratory pause, high inspiratory to expiratory ratio, and so on. However, it is unclear whether those settings improve aerosol delivery. Thus, we aimed to evaluate the impact of ventilator settings on aerosol delivery during mechanical ventilation (MV).
View Article and Find Full Text PDFRespir Care
April 2024
Critical Care Department, Hospital Clínico San Carlos, Madrid, Spain.
Background: Open respiratory secretion suctioning with a catheter causes pain and tracheobronchial mucosal injury in intubated patients. The goal of mechanical insufflation-exsufflation (MI-E) is to move secretions proximally and noninvasively by generating a high peak expiratory air flow. Nebulized hypertonic saline with hyaluronic acid (HS-HA) may facilitate suctioning by hydration.
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