Pathogenesis and Prevention of Tracheobronchial Damage with Suction Procedures

Sackner, Marvin A.; Landa, Jose; Greeneltch, Ned; Robinson, Morton J.

doi:10.1378/chest.64.3.284

Cited by 74 publications

(14 citation statements)

References 6 publications

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“…Currently, blind suctioning through a small flexible catheter is the most common method to remove secretions from within the ETT. 22 This maneuver can injure the tracheal mucosa, 23 decrease lung volume leading to hypoxia, 24 trigger cardiac arrhythmias, 25 and increase intracranial pressure. 26 In addition, the use of blind suctioning has also been associated with further impairment of tracheal mucociliary clearance function 27 together with dislodging emboli of pathogens from the ETT biofilm to the lower airway.…”

Section: Discussionmentioning

confidence: 99%

Endotracheal Tubes Cleaned With a Novel Mechanism for Secretion Removal: A Randomized Controlled Clinical Study

et al. 2016

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INTRODUCTION: Intubation compromises mucus clearance, allowing secretions to accumulate inside the endotracheal tube (ETT). The purpose of this trial was to evaluate a novel device for ETT cleaning. We hypothesized that its routine use would reduce tube occlusion due to mucus accumulation, while decreasing airway bacterial colonization. METHODS: Subjects were randomized to either the use of the device every 8 h, or the institutional standard of care (blind tracheal suction) only. ETTs were collected at extubation and analyzed with high-resolution computed tomography (HRCT) for quantification of mucus volume. Microbiological testing was performed on biofilm samples. Vital signs and ventilatory settings were collected at the bedside. In-hospital follow-up was conducted, and a final evaluation survey was completed by respiratory therapists. RESULTS: Seventy-four subjects expected to remain intubated for longer than 48 h were enrolled (77 ETTs, 37 treatment vs 40 controls). Treated tubes showed reduced mucus accumulation (0.56 ؎ 0.12 vs 0.71 ؎ 0.28 mL; P ‫؍‬ .004) and reduced occlusion (6.3 ؎ 1.7 vs 8.9 ؎ 7.6%; P ‫؍‬ .039). The HRCT slice showing the narrowest lumen within each ETT exhibited less occlusion in cleaned tubes (10.6 ؎ 8.0 vs 17.7 ؎ 13.4%, 95% CI: 2-12.1; P ‫؍‬ .007). Data on microbial colonization showed a trend in the treatment group toward a reduced ETT-based biomass of bacteria known to cause ventilator-associated pneumonia. No adverse events were reported. The staff was satisfied by the overall safety and feasibility of the device. CONCLUSION: The endOclear is a safe and effective device. It prevents luminal occlusion, thereby better preserving ETT nominal function.

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Section: Discussionmentioning

confidence: 99%

Endotracheal Tubes Cleaned With a Novel Mechanism for Secretion Removal: A Randomized Controlled Clinical Study

et al. 2016

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“…2,3 Indications for endotracheal suctioning have been studied by only a few researchers. In 1976, Amborn 4 published the results of an assessment of 22 clinical signs that might indicate the presence of secretions, which were defined as a volume of secretions 0.5 mL or greater obtained via open suctioning methods 1 hour after a baseline suctioning procedure.…”

Section: Introductionmentioning

confidence: 99%

Clinical Indicators for Endotracheal Suctioning in Adult Patients Receiving Mechanical Ventilation

Sole

Bennett

Ashworth

2015

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Identify the recommended assessment parameters to determine the need for endotracheal suctioning in patients receiving mechanical ventilation. 2. Explain the potential for inaccurate assessment of the need for endotracheal suctioning based on the most frequently used clinical indicators. 3. Discuss which clinical assessments, according to study findings, best indicate the need for endotracheal suctioning, and why.To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue. " No CE test fee for AACN members.Background Critically ill patients who need mechanical ventilation require endotracheal suctioning. Guidelines recommend coarse crackles over the trachea and/or the presence of a sawtooth pattern on the flow-volume loop of the ventilator waveform as the best indicators. Objective To determine clinical cues for endotracheal suctioning in patients who require mechanical ventilation. Methods A descriptive study of 42 adult patients receiving mechanical ventilation. After baseline endotracheal suctioning with a closed-system device, patients were assessed hourly up to 4 hours for guideline-based cues for endotracheal suctioning and lung sounds were auscultated. Endotracheal suctioning was done when cues were detected or 4 hours after baseline suctioning. Secretions were collected, measured, and weighed. Results Most patients were male (62%) and white (93%). Mean age was 51 years, and mean duration of mechanical ventilation was 7.5 days. The median time to endotracheal suctioning was 2 hours, and a mean of 4.4 mL of secretions was removed. Three patients had no cues identified but had 1.0 mL or more of secretions. The most frequent cues were crackles over the trachea (88%), sawtooth waveform (33%), coughing (29%), and visible secretions (5%). Cues resolved and physiological parameters improved after suctioning. Coarse lung sounds did not improve.Conclusions Patients receiving mechanical ventilation should be routinely assessed for coarse crackles over the trachea, the most common indicator for endotracheal suctioning. Despite common practice, assessment of lung sounds to identify the need for suctioning is not supported. by AACN on May 11, 2018 http://ajcc.aacnjournals.org/ Downloaded from C ritically ill patients treated with mechanical ventilation require an artificial airway, either an endotracheal tube or a tracheostomy tube. These patients often retain tracheobronchial secretions because of impaired cough reflex, decreased mucociliary clearance, and, possibly, increased mucus production. Endotracheal suctioning is essential to remove retained tracheobronchial secretions, and nurses and respiratory care practitioners assume the responsibility for removal. The 2010 clinical practice guidelines 1 for endotracheal suctioning of the American Association of Respiratory Care specify that endotracheal suctioning should be done when clinically ind...

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“…It has been shown that high oxygen concentrations, dry anesthetic gases, trauma due to aspiration procedures and the cuff of the endotracheal tube may lower mucociliary clearance. [14][15][16][17][18][19][20][21] In addition, volatile anesthetics inhibit ciliary motility and impair bronchociliary clearance in a time and dosedependent manner. As a result of mucociliary impairment in the postoperative period, the rate of atelectasis and lower respiratory tract infections increases due to the retention of secretions.…”

Section: Discussionmentioning

confidence: 99%