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PubMed2002

Suction vs water seal after pulmonary resection: a randomized prospective study.

STUDY OBJECTIVE: To evaluate whether suction or water seal is superior in the management of chest tubes after pulmonary resection. DESIGN: A prospective, randomized, controlled trial. After an initial, brief period of suction, patients were randomized to water seal or - 20 cm H(2)O suction. SETTING: University hospital. PATIENTS: Sixty-eight patients who underwent wedge resection, segmentectomy, or lobectomy were included in the study. Those patients who underwent reoperative surgery or lung volume reduction surgery were excluded. RESULTS: There were 34 patients in each group. The two groups were evenly matched for age, sex, operation performed, severity of lung disease, and nutritional status. Fifteen patients in each group (44%) had an air leak at the completion of surgery. The duration of the air leak was shorter in the water seal group than in the suction group (mean +/- SEM, 1.50 +/- 0.32 days vs 3.27 +/- 0.80 days, respectively; p = 0.05). The mean times to removal of chest tubes were 3.33 +/- 0.35 days in the water seal group and 5.47 +/- 0.98 days in the suction group (p = 0.06). The length of stapled parenchyma was measured for each patient and averaged 24.9 cm for the water seal group and 18.5 cm for the suction group (p = 0.18). When corrected for the length of staple lines, the duration of air leaks and days with chest tube were dramatically lower in the water seal group (p = 0.02 and p = 0.02, respectively). CONCLUSION: Placing chest tubes on water seal after a brief period of suction after pulmonary resection shortens the duration of the air leak and likely decreases the time that the chest tubes remain in place. Adoption of this practice may result in lower morbidity and lower hospital costs.

Aged↗
PubMed1987

Plasma arginine vasopressin during neck suction in upright sitting man.

In order to examine the influence of carotid baroreceptor stimulation on arginine vasopressin secretion, 8 normal healthy males were subjected to static neck suction of -3.3 kPa for 20 min in the upright sitting position after overnight food and fluid restriction. The plasma concentration of arginine vasopressin did not change significantly during neck suction. However, in 3 subjects the termination of neck suction induced large increases in plasma arginine vasopressin from 1.8 to 63.7 ng/l, from 0.7 to 34.3 ng/l and from 2.1 to 19.0 ng/l, respectively. Two subjects experienced symptoms such as nausea and paleness during neck suction. Systolic arterial pressure increased slightly but significantly during neck suction from 15.3 +/- 0.3 to 15.7 +/- 0.4 kPa (N = 7, P less than 0.05), whereas mean arterial pressure, diastolic arterial pressure, central venous pressure, heart rate, plasma osmolality, plasma sodium and potassium were unchanged. Haemoglobin concentration in blood and haematocrit increased significantly during and after neck suction, whereas plasma volume decreased. We conclude that neck suction with a negative pressure of 3.3 kPa in upright sitting man does not significantly affect plasma arginine vasopressin. However, termination of the stimulation induces large increases in some subjects. This may be explained by a direct effect on the vagus nerve or by a selective deloading of carotid baroreceptors.

Adult↗
PubMed1999

Instillation of normal saline during endotracheal suctioning: effects on mixed venous oxygen saturation.

BACKGROUND: Instillation of normal saline before endotracheal suctioning is thought to facilitate removal of secretions and ultimately to improve the patient's oxygenation status. To date, no studies have used an in vivo measure of oxygenation such as mixed venous oxygen saturation to characterize the effects of instillation of normal saline. OBJECTIVES: To describe the effects of instillation of normal saline into an endotracheal tube before suctioning on mixed venous oxygen saturation in critically ill adult patients. METHODS: In a descriptive, observational study, 35 patients were assigned to either of 2 groups after coronary artery bypass grafting. One group had 5 mL of normal saline instilled at the start of endotracheal tube suctioning; the other group had the same endotracheal tube suctioning procedure without the use of saline. Data on mixed venous oxygen saturation were recorded at 1-minute intervals for a 5-minute baseline period and then throughout the suctioning procedure until mixed venous oxygen saturation returned to baseline levels. RESULTS: The time required for mixed venous oxygen saturation to return to baseline values after suctioning was an average of 3.78 minutes longer when saline was used. CONCLUSIONS: Instillation of normal saline before endotracheal suctioning has an adverse effect on oxygenation as indicated by mixed venous oxygen saturation. This finding contradicts the assumption that instillation of normal saline improves oxygenation status.

Adult↗
PubMed2002

Bacterial growth in secretions and on suctioning equipment of orally intubated patients: a pilot study.

BACKGROUND: Contamination of equipment, colonization of the oropharynx, and microaspiration of secretions are causative factors for ventilator-associated pneumonia. Suctioning and airway management practices may influence the development of ventilator-associated pneumonia. OBJECTIVES: To identify pathogens associated with ventilator-associated pneumonia in oral and endotracheal aspirates and to evaluate bacterial growth on oral and endotracheal suctioning equipment. METHODS: Specimens were collected from 20 subjects who were orally intubated for at least 24 hours and required mechanical ventilation. At baseline, oral and sputum specimens were obtained for culturing, and suctioning equipment was changed. Specimens from the mouth, sputum, and equipment for culturing were obtained at 24 hours (n=18) and 48 hours (n=10). RESULTS: After 24 hours, all subjects had potential pathogens in the mouth, and 67% had sputum cultures positive for pathogens. Suctioning devices were colonized with many of the same pathogens that were present in the mouth. Nearly all (94%) of tonsil suction devices were colonized within 24 hours. Most potential pathogens were gram-positive bacteria. Gram-negative bacteria and antibiotic-resistant organisms were also present in several samples. CANCLUSIONS: The presence of pathogens in oral and sputum specimens in most patients supports the notion that microaspiration of secretions occurs. Colonization is a risk factor for ventilator-associated pneumonia. The equipment used for oral and endotracheal suctioning becomes colonized with potential pathogens within 24 hours. It is not known if reusable oral suction equipment contributes to colonization; however, because many bacteria are exogenous to patients' normal flora, equipment may be a source of cross-contamination.

Adult↗
PubMed2002

Closed versus open suctioning techniques.

Airway suctioning is classically performed with the disconnection of the patient from the ventilator and the introduction of the suction catheter into the endotracheal tube. Alternatively, it can be accomplished with a closed suctioning system included in the ventilatory circuit, allowing to introduce the suction catheter into the airways without disconnecting the patient from the ventilator. The closed-suction system has some advantages compared to the conventional, open-suction technique. It can be helpful in limiting environmental, personnel and patient contamination and in preventing the loss of lung volume and the alveolar derecruitment associated with standard suctioning in the severely hypoxemic patients. However, the impact of the closed system on ventilator-associated pneumonia as well as its cost-effectiveness and the influence of such devices with ventilatory support remain to be assessed.

Humans↗
PubMed2003

A multisite survey of suctioning techniques and airway management practices.

BACKGROUND: Ventilator-associated pneumonia, common in critically ill patients, is associated with microaspiration of oropharyngeal secretions and may be related to suctioning and airway management practices. OBJECTIVES: To describe institutional policies and procedures related to closed-system suctioning and airway management of intubated patients, and to compare practices of registered nurses and respiratory therapists. METHODS: A descriptive, comparative, multisite study of facilities that use closed-system suctioning devices on most intubated adults was conducted. Nurses and respiratory therapists who worked at the sites completed surveys related to their practices. RESULTS: A total of 1665 nurses and respiratory therapists at 27 sites throughout the United States responded. The typical respondent had at least 6 years' experience with patients receiving mechanical ventilation (61%) and a baccalaureate degree or higher (54%). Most sites had policies for management of endotracheal tube cuffs (93%), hyperoxygenation (89%) and use of gloves (70%) with closed-system suctioning, and instillation of isotonic sodium chloride solution for thick secretions (74%). Only 48% of policies addressed oral care and 37% addressed oral suctioning. Nurses did more oral suctioning and oral care than respiratory therapists did, and respiratory therapists instilled sodium chloride solution more and rinsed the suctioning device more often than nurses did. CONCLUSIONS: Policies vary widely and do not always reflect current research. Consistent performance of practices such as wearing gloves for airway management and maintaining endotracheal cuff pressures must be evaluated. Collaborative, research-based policies and procedures must be developed and implemented to ensure best practices for intubated patients.

Adult↗
PubMed2004

Influence of suction tube noise on hearing in pediatric patients who received ventilation tube insertion.

BACKGROUND: Myringotomy with ventilation tube insertion is the most frequently used surgical procedure performed on children to treat otitis media with effusion. The risk of acoustic trauma caused by the suctioning noise during the procedure has not been clearly understood. The objective of this study was to investigate whether the suctioning noise during ventilation tube placement procedure damaged children's hearing. METHODS: The study was conducted in a prospective manner. The ventilation tube placement procedures were performed on a series of 30 consecutive patients (60 ears). The electro-acoustic signals of the suctioning noises during the procedure were analyzed using a high quality digital tape recording system. The hearing threshold was measured using pure tone audiometry before and after the procedures. RESULTS: The peak intensity of the suctioning noise ranged from 4 kHz to 10 kHz in frequency. The mean intensities of the suctioning noise were 86.4 +/- 9.6 dB for serous effusion and 96.4 +/- 9.6 dB for mucoid effusion, respectively. No noise-induced sensori-neural hearing loss was observed in this cohort. CONCLUSIONS: Even though the peak intensity of the suctioning noise may reach a level of more than 90 dB, it is not likely that the suctioning noise during the ventilation tube placement procedure causes noise-induced sensori-neural hearing loss.

Adolescent↗
PubMed2005

Effectiveness evaluation of different suction systems.

Microorganisms of the patient's oral cavity and his/her blood and saliva may cause different air-borne and blood-borne infectious diseases among odontologists and their assistants who work with patients. Quantitative analysis and spatial distribution analysis of the environmental spread of oral liquid and cooling liquid mixture were performed during this study. Effectiveness of suction systems of four types was evaluated: without suction, using a small-size suction pump alone, using a small-size and large-size suction pumps, using a small-size suction pump together with an experimental extra-oral aspirator. Quantitative changes of the water aerosol, which enters the environment during the preparation of teeth, were determined in respect of the used suction systems. The small-size pump system together with an experimental extra-oral suction system eliminated best the aerosol formed during the preparation.

Aerosols↗
PubMed1991

Effect of lung hyperinflation and endotracheal suctioning on heart rate and rhythm in patients after coronary artery bypass graft surgery.

We examined the effect of lung hyperinflation and suction on PaO2, heart rate, and rhythm in patients after coronary artery bypass graft surgery (N = 26). Three lung hyperinflation breaths, at one of five randomly ordered volumes (tidal volume, 12 cc/kg, 14 cc/kg, 16 cc/kg, or 18 cc/kg of lean body weight) were delivered, by a ventilator (fraction of inspired oxygen 1.0), followed by 10 seconds of continuous suction. Lung hyperinflation and suctioning were repeated three times. Repeated-measures analysis of variance revealed a statistically significant increase (p = 0.000) in PaO2 immediately after the third suction pass, which was volume dependent (p = 0.009). A statistically significant (p less than 0.001) increase in heart rate from baseline occurred over the three lung hyperinflation-suctioning sequences that was not volume dependent. The mean increase in heart rate was 6.8 beats/min. The majority of rhythm changes for lung hyperinflation and suctioning were from normal sinus rhythm to sinus tachycardia. Suction was associated with a greater incidence of rhythm (53.9%) and arrhythmia (80.8%) changes. The most frequent arrhythmia was premature atrial contraction.

Adult↗
PubMed1987

Removal of tracheal secretions in anesthetized dogs: balloon catheters versus suction.

Artificial secretions were removed by suction (using 12- or 18-French suction catheters) or by means of a balloon-tipped catheter (6-French Fogarty arterial embolectomy catheter) in 20 experiments performed on five dogs anesthetized with halothane. Each dog had 5 ml of mucin injected 10 cm down the endotracheal tube prior to a 30-sec period of intermittent positive pressure ventilation. After this procedure, the ventilator was disconnected and the secretions were removed by suction with the 12- or 18-French catheters or by the Fogarty catheter. Each dog had balloon removal performed twice and suction performed once with the 12-French and once with the 18-French catheter. The endotracheal tube was cleaned and a 15-min stabilization period was allowed between each experiment. Arterial blood pressure (MAP) and pulmonary artery pressure (PAP) did not change after either technique. There were no ECG changes, arrhythmias, or alterations in PaCO2. The PaO2 was significantly lower in the two suction catheter groups [520 +/- 33 mm Hg (12 French) and 451 +/- 31 mm Hg (18 French)] than in the balloon removal group (564 +/- 10 mm Hg) (P less than 0.05). The balloon technique removed more secretions (4.52 +/- 0.06 ml) than did suction (12 French, 1.32 +/- 0.17 ml; 18 French, 2.11 +/- 0.44 ml). Balloon removal of tracheal secretions has two advantages over conventional suction techniques: it removes more secretions, and it has less detrimental effect on arterial oxygenation.

Anesthesia, Endotracheal↗
PubMed1987

Intratracheal suctioning in sick preterm infants: prevention of intracranial hypertension and cerebral hypoperfusion by muscle paralysis.

In a prospective nonrandomized study, using each baby as his or her own control, we compared intracranial pressure (anterior fontanel pressure as measured with the Digilab pneumotonometer), cerebral perfusion pressure, BP, heart rate, transcutaneous Po2, and transcutaneous Pco2 before, during, and after endotracheal suctioning, with and without muscle paralysis, in 28 critically ill preterm infants with respiratory distress syndrome. With suctioning, there was a small but significant increase in intracranial pressure in paralyzed patients (from 13.7 [mean] +/- 4.4 mm Hg [SD] to 15.8 +/- 5.2 mm Hg) but a significantly larger (P less than .001) increase when they were not paralyzed (from 12.5 +/- 3.6 to 28.5 +/- 8.3 mm Hg). Suctioning led to a slight increase in BP with (from 45.3 +/- 9.1 to 48.0 +/- 8.7 mm Hg) and without muscle paralysis (from 45.1 +/- 9.4 to 50.0 +/- 11.7 mm Hg); but there was no significant difference between the two groups. The cerebral perfusion pressure in paralyzed infants did not show any significant change before, during, and after suctioning (31.5 +/- 9.1 mm Hg before v 32.0 +/- 8.7 mm Hg during suctioning), but without muscle paralysis cerebral perfusion pressure decreased (P less than .001) from 32.8 +/- 9.7 to 21.3 +/- 13.1 mm Hg. Suctioning induced a slight decrease in mean heart rate and transcutaneous Po2, but pancuronium did not alter these changes. There was no statistical difference in transcutaneous Pco2 before, during, and after suctioning with and without muscle paralysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Gas Monitoring, Transcutaneous↗
PubMed1979

[A new suction pump to be used in the field of emergency medicine (author's transl)].

In the field of emergency medicine there has been a need for an efficient suction pump that can be used under all types of conditions and included both in doctors' emergency kits as well as in the standard equipment of mobile units such as ambulance cars, helicopters etc. The devices available in the past had decided disadvantages in their construction and performance. A newly designed suction pump -- the AMBU Uni-Suction -- has been subjected to laboratory and practical tests concerning function, material and practical use, based on a specification of requirements for such a device. The results show that this universally applicable suction pump meets every requirement under the different test conditions. The effectiveness is good, irrespective of the mode of operation applied, i.e. by hand, by foot or by compressed gases. Maintenance and service are negligible and no susceptibility to malfunction was observed. In addition, the design, function and performance of an accessory unit, the Suction Booster, are presented. This device can be used effectively in combination with the new suction pump, or with any other type of suction unit to prevent dangerous aspiration in emergencies.

Clinical Trials as Topic↗
PubMed1993

The effect of saline lavage prior to suctioning.

OBJECTIVE: To determine the effect on oxygen saturation of instilling a saline bolus into artificial airways prior to suctioning, as measured by pulse oximeter. DESIGN: Quasi-experimental, single-case, counterbalanced design. SETTING: The surgical, medical and coronary intensive care units of a federal, teaching medical center. SUBJECTS: Subjects were 40 men, more than 40 years old, in need of intensive care nursing and mechanical ventilation. INTERVENTIONS: Subjects were suctioned as needed for 24 hours. A 5-mL saline bolus was instilled every other time the subject was suctioned. Outcome measurements were done immediately before and after suctioning and at 1-minute intervals for 5 minutes after suctioning. MAIN OUTCOME MEASURES: Noninvasive oxygen saturation values. RESULTS: The instillation of a saline bolus was found to have an adverse effect on oxygen saturation that worsened over time. Significant changes in oxygen saturation as a result of saline bolus instillation were found at 2,3,4 and 5 minutes after instillation. CONCLUSIONS: These results indicate that instilling saline prior to suctioning has an adverse effect on oxygen saturation. These results support the recommendation that the practice of instilling saline prior to suctioning should be abandoned as a routine procedure. More study is needed to investigate whether a specific group of patients may actually benefit from this procedure.

Aged↗
PubMed1993

[The effect of intracranial pressure caused by airway suction in hypertensive intracerebral hemorrhagic comatose patients].

Ten hypertensive intracerebral hemorrhagic comatose patients in the Neurosurgical Intensive Care Unit were involved in this study. The ten were within the range of 5 to 8 by Glasgow Coma Scale, and all had undergone tracheostomy. During suction of the airway for 20 seconds in 4 areas (trachea, bronchus, nasal and oral cavities), the data of intracranial pressure (ICP), arterial blood pressure, pulse rate (PR) and respiration rate (RR) were recorded. Results were analyzed for ICP, mean arterial blood pressure (MABP), PR, RR, and cerebral perfusion pressure (CPP) at the 5th, 10th, 15th and 20th seconds in the above-mentioned areas. The ICP was found to be significantly increased, and above the 20 mmHg mark, during suction of the bronchus or nasal cavity for 5 seconds. The MABP also showed significant increase, to above the 110 mmHg mark during 5-second suction of the trachea or nasal cavity or during suction of the bronchus or oral cavity for 10 seconds. However, during the suction of the four airway areas, PR and RR were less influenced and the CPP was not decreased or significantly changed. The conclusion of this study was that suction in the areas of trachea, bronchus and nasal cavity, should not exceed 5 to 10 seconds; in the oral cavity, it may be done within 10 to 15 seconds and at each procedure of airway suction. If it is not possible to clean the sputum or secretion in one procedure, the patient should be allowed to rest for about one minute or become stabilized as determined by watching the monitors of ICP, BP, PR, and RR.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

Effect of neuromuscular blockers and opiates on the cerebrovascular response to endotracheal suctioning in adults with severe head injuries.

BACKGROUND: Intracranial hypertension occurs in response to routine procedures such as endotracheal suctioning in patients with severe head injuries. In some patients, the intracranial pressure does not immediately return to baseline levels. OBJECTIVES: To examine the effect of drug administration on cerebrovascular response to endotracheal suctioning in adults with severe head injuries. METHODS: Seventy-one subjects were divided into 3 groups: those who received no drugs, those treated with opiates only (morphine sulfate and fentanyl citrate), and those treated with a neuromuscular blocking agent (vecuronium bromide) plus opiates. A controlled protocol involving 2 sequences of endotracheal suctioning that included hyperoxygenation, hyperinflation, and suctioning was used for all subjects. Two-way repeated-measures analyses of variance were done with type of drug as the between-subject factor and phase of suctioning as the within-subject factor. Survival analysis was used to compare the return of intracranial pressure to baseline levels among the 3 groups. RESULTS: Changes in intracranial pressure were significantly smaller in subjects who received a neuromuscular blocking agent plus opiates than in subjects who did not receive any drugs or received opiates only. The greatest increase in intracranial pressure from baseline was in the first and second phases of suctioning. The 3 groups showed no significant difference in the return of intracranial pressure to baseline level. CONCLUSIONS: Neuromuscular blockers attenuate the increases in intracranial pressure that occur with endotracheal suctioning. It is not known whether control of procedurally induced elevations in intracranial pressure affects long-term outcomes in adults with severe head injuries.

APACHE↗
PubMed1989

Cardiopulmonary responses to the tracheobronchial suction with a fiberoptic bronchoscope during and after anesthesia.

The cardiopulmonary responses to endobronchial suction with a fiberoptic bronchoscope (FOB suction) during and after anesthesia were compared in 12 patients underwent elective surgeries. FOB suction for 1 mm was performed during enflurane anesthesia (1.5% enflurane in oxygen) with muscle relaxant (anesthetized stage) and after anesthesia during spontaneously breathing of oxygen (awake stage). FOB suction lowered PaO2 to a greater extent in the awake than in the anesthetized stage. Mean PaO2 decreased from 414 to 111 torr in the awake and from 447 to 333 in the anesthetized stage. During suction, PaCO2 slightly increased in both stages. In response to FOB suction, heart rate increased significantly in the awake stage (P < 0.001), while mean blood pressure increased significantly in the anesthetized stage (P < 0.01). These findings indicate that the cardiopulmonary responses to FOB suction for 1 min during and after anesthesia differed. The procedure might be less dangerous during anesthesia.

Journal Article↗
PubMed1995

Retransfusion of suctioned blood during cardiopulmonary bypass impairs hemostasis.

In a previous study we observed extensive clotting and fibrinolysis in blood from the thoracic cavities during cardiopulmonary bypass. We hypothesized that retransfusion of this suctioned blood could impair hemostasis. In this prospective clinical study we investigated the effect of suctioned blood retransfusion on systemic blood activation and on postoperative hemostasis. During coronary artery bypass grafting in 40 patients, suctioned blood was collected separately. It then was retransfused to the patient at the end of the operation (n = 19), or it was retained (n = 21). During the study, 12 consecutive patients, randomized in two groups of 6, were analyzed for biochemical parameters indicating blood activation and clotting. The immediate and significant increase in circulating concentrations of thrombin-antithrombin III complex, tissue-type plasminogen activator, fibrin degradation products, and free plasma hemoglobin demonstrated the effect of suctioned blood retransfusion. Moreover, the increased concentrations of thrombin-antithrombin III complex and fibrin degradation products indicated renewed systemic clotting and fibrinolysis as a direct result of the retransfusion of suctioned blood. Concentrations of all indicators mentioned remained significantly lower in the retainment group. The clinical data showed that retainment of suctioned blood resulted in significantly decreased postoperative blood loss (822 mL in the retransfusion group versus 611 mL in the retainment group; p < 0.05) and similar or even reduced consumption of blood products (513 versus 414 mL red blood cell concentrate and 384 versus 150 mL single-donor plasma; both not significant). We conclude that retransfusion of highly activated suctioned blood during cardiopulmonary bypass exacerbates wound bleeding.

Blood Transfusion, Autologous↗
PubMed2003

Correlations between small aperture skin suction parameters: statistical analysis and mechanical model.

BACKGROUND/AIMS: Skin suction experiments are widely used in order to evaluate the effects of skin treatments, both for cosmetic and for dermatological purposes. Classically, the elevation of the skin is measured at different discrete time instances after the pressure has been changed. Relations between the classical parameters - Uv, Ur, Ue and Uf - have been investigated and used in order to develop a new model for interpreting the mechanical properties of the skin. METHODS: Within a group of 68 female subjects - aged between 37 and 68 - a Cutometer has been used in order to determine classical skin suction parameters on the female facial skin. Each skin suction measurement consists of three consecutive underpressure cycles. Within the resulting parameter set, a statistical analysis has been performed to investigate interparameter relations. RESULTS: Strong interparameter correlations have been found within a set of 12 classical skin suction parameters. The set contains three independent groups of interrelated parameters. Based on this observation, a one-dimensional mechanical model - consisting of springs and dampers - is constructed. When two extra independent parameters are included in the model, the elevation versus time curves as recorded during three consecutive underpressure cycles can be fully described. The model reveals that typical skin suction data can be described in terms of a quick and a slow deformation process. The two characteristic time scales are 0.1 and 7 s approximately. The 0.1 s-value matches the response time of the device used. In reality, the quick deformation process in the skin may have a shorter time scale. CONCLUSIONS: In skin suction data, each underpressure cycle is usually characterized by four classical parameters - Uv, Ur, Ue and Uf. Within the 12 parameters of a three-cycle measurement, three independent groups of interrelated parameters have been found. These groups can be represented by the parameters Uv1, Ur1 and Uf1 of the first underpressure cycle. A model that is based on these three independent groups and two other independent parameters is proposed. The model provides an accurate description of the skin deformation as recorded during a measurement involving three underpressure cycles. The model is an improvement over classical interpretations of skin suction data where interrelated parameters are used. Moreover, the five-parameter model accounts for well-known mechanical characteristics of the skin such as preconditioning and visco-elastic behavior.

Adaptation, Physiological↗