Open and Closed Endotracheal Suction Systems Divergently Affect Pulmonary Function in Mechanically Ventilated Subjects

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dc.contributor.authorRaimundo, Rodrigo Daminello
dc.contributor.authorSato, Monica Akemi
dc.contributor.authorSilva, Talita Dias da
dc.contributor.authorAbreu, Luiz Carlos de
dc.contributor.authorValenti, Vitor Engracia [UNESP]
dc.contributor.authorRiggs, Daniel William
dc.contributor.authorCarll, Alex Perrow
dc.contributor.institutionFac Med ABC
dc.contributor.institutionUniversidade Federal do Espírito Santo (UFES)
dc.contributor.institutionHarvard Sch Publ Hlth
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionUniv Cidade Sao Paulo
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.contributor.institutionUniv Louisville
dc.date.accessioned2021-06-26T06:17:40Z
dc.date.available2021-06-26T06:17:40Z
dc.date.issued2021-05-01
dc.description.abstractBACKGROUND: In mechanically ventilated subjects, intra-tracheal secretions can be aspirated with either open suction systems (OSS) or closed suction systems (CSS). In contrast to CSS, conventional OSS require temporarily disconnecting the patient from the ventilator, which briefly diminishes PEEP and oxygen supply. On the other hand, CSS are more expensive and less effective at aspirating secretions. Thus, it was hypothesized that the 2 procedures differentially affect pulmonary and cardiovascular parameters after suction. METHODS: Subjects in the ICU (N = 66) were quasi-randomized for initial treatment with OSS or CSS in a crossover design. To compare the potential for these suction systems to compromise cardiorespiratory stability, changes in cardiopulmonary physiology were assessed from before to just after use of each suction system (three 10-s aspirations). RESULTS: For most pulmonary and cardiovascular parameters (ie, peak inspiratory pressure, airway resistance, pressure plateau, heart rate, and arterial pressures), the effects of aspiration inversely correlated with baseline values for that parameter, with a similar regression slope between suction systems. However, when controlling for baseline values, OSS caused significantly greater increases in airway resistance and peak inspiratory pressure (P < .001 and < .01 vs CSS, respectively). CONCLUSIONS: Elevated airway resistance prior to endotracheal suction may justify use of a CSS and contraindicate a conventional OSS in mechanically ventilated subjects. Adoption of this approach into clinical guidelines may prevent suction-induced pulmonary injury in subjects, especially for those with underlying diseases involving increased airway resistance or increased alveolar pressure.en
dc.description.affiliationFac Med ABC, Lab Delineamento Estudos & Escrita Cient, Santo Andre, SP, Brazil
dc.description.affiliationUniv Fed Espirito Santo UFES, Dept Educ Integrada Saude, Vitoria, ES, Brazil
dc.description.affiliationHarvard Sch Publ Hlth, Dept Environm Hlth, 677 Huntington Ave, Boston, MA 02115 USA
dc.description.affiliationUniv Fed Sao Paulo, Dept Cardiol, Sao Paulo, SP, Brazil
dc.description.affiliationUniv Cidade Sao Paulo, Fac Med, Sao Paulo, Brazil
dc.description.affiliationUniv Estadual Paulista, Dept Escudos Sistema Nervoso Auton, Fac Ciencias & Tecnol, Presidente Prudente, SP, Brazil
dc.description.affiliationUniv Louisville, Diabet & Obes Ctr, Christina Lee Brown Envirome Inst, Sch Med, Louisville, KY USA
dc.description.affiliationUniv Louisville, Dept Physiol, Sch Med, Louisville, KY USA
dc.description.affiliationUnespUniv Estadual Paulista, Dept Escudos Sistema Nervoso Auton, Fac Ciencias & Tecnol, Presidente Prudente, SP, Brazil
dc.format.extent785-792
dc.identifierhttp://dx.doi.org/10.4187/respcare.08511
dc.identifier.citationRespiratory Care. Irving: Daedalus Enterprises Inc, v. 66, n. 5, p. 785-792, 2021.
dc.identifier.doi10.4187/respcare.08511
dc.identifier.issn0020-1324
dc.identifier.urihttp://hdl.handle.net/11449/210775
dc.identifier.wosWOS:000646202900011
dc.language.isoeng
dc.publisherDaedalus Enterprises Inc
dc.relation.ispartofRespiratory Care
dc.sourceWeb of Science
dc.subjectendotracheal aspiration
dc.subjectairway resistance
dc.subjectpulmonary compliance
dc.subjectmechanical ventilation
dc.subjectpulmonary pressure
dc.subjectlung
dc.titleOpen and Closed Endotracheal Suction Systems Divergently Affect Pulmonary Function in Mechanically Ventilated Subjectsen
dc.typeArtigo
dcterms.rightsHolderDaedalus Enterprises Inc
unesp.author.orcid0000-0002-4683-4671[3]

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