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At least 19 recordsLinked to original sources
PubMed1991

Physiological responses to endotracheal and oral suctioning in paediatric patients: the influence of endotracheal tube sizes and suction pressures.

OBJECTIVE: To study the influence of varying outer suction catheter (SC) diameter (OD) to inner endotracheal tube (ETT) diameter (ID) and suction pressures (SP) on heart rate (HR), respiratory rate (RR), mean arterial pressure (MAP), arterial oxygen saturation (SaO 2) and intracranial pressure (ICP) during ETT and oral suctioning. An additional aim was to define an optimal suction catheter size that would prove easy to introduce and be rapidly effective in clearing secretions with the least physiological alteration. DESIGN: Prospective study. SETTING: Paediatric intensive care unit. PATIENTS: Ventilated paediatric patients. INTERVENTION: Patients had ETT suctioning performed in a random fashion using suction catheters with SC outer diameter to inner ETT diameter of approximately 0.4, 0.7 and 0.9 using varying pressures (80, 100, 120 mmHg). Using the medium size suction catheter (OD/ID = 0.7) at 100 mmHg of suction pressure, oral suctioning was compared to ETT suctioning. MEASUREMENTS AND MAIN RESULTS: Seventeen patients were studied (age 6.5 + 5 months). All suction catheters at varying pressures resulted in similar transient alterations in HR, RR, MAP, SaO 2 and ICP following ETT suctioning. Significant changes were seen in SaO 2, HR and ICP, irrespective of the catheter diameter or suction pressure. Oral suctioning resulted in similar trends and magnitude of changes as for ETT suctioning in MAP, RR, HR, and ICP, but less change occurred in the SaO 2 (p less than 0.05). The catheters with OD/ID of 0.7 were easiest to introduce and most effective in clearing secretions. CONCLUSION: Our study suggests that: 1. Tracheal toilet using variations in OD/ID ratios and SP within limits tested resulted in similar significant adverse changes in HR, ICP and SaO 2 and similar trends in RR and MAP. 2. Based on the ease of introduction and the effectiveness of clearing secretions, a medium SC (OD/ID = 0.7) is most appropriate for infants and children. 3. Oral suctioning also results in adverse physiological changes, therefore similar precautions to those taken during tracheal suctioning should be followed for oral suctioning.

Blood Pressure↗
PubMed1988

[Does directed bronchoscopic bronchial cleansing have an advantage over conventional suctioning? A prospective study of hemodynamics, gas exchange and suction-induced mucosal lesions in long-term ventilated patients].

Hypoxic complications and epithelial damage to the trachea and bronchi during conventional blind suctioning have been described in the literature. Fiberoptic suctioning and examination of the trachea of each long-term ventilator patient as a routine method has been recommended in recent studies. We investigated the effect of a conventional tracheal suction technique compared to precise fiberbronchoscopic suction on cardiocirculatory function and gas exchange in mechanically ventilated patients. METHOD. In 40 long-term ventilator patients tracheobronchial toilet was performed either conventionally (group I; n = 20; 15 s of endotracheal suction with no mechanical ventilation during suctioning) or bronchoscopically (group II; n = 20; bronchoscope Olympus 1 T 10; mechanical ventilation during suctioning). Measurements were performed before, immediately after, and 1, 2, 5, and 15 min after suctioning. FIO2 was not changed before or after suctioning. In 12 long-term ventilator patients (greater than or equal to 8 days) we looked for tracheal mucosal lesions produced by conventional suctioning. RESULTS. There was no effect on cardiocirculatory function in either group (Figs. 1 and 2), but we found a decrease in arterial PO2 after suctioning in all patients (group I from 99 +/- 25 to 81 +/- 19 mmHg, group II from 104 +/- 23 to 80 +/- 17 mmHg [Fig. 3]). The time needed to re-establish the initial PaO2 after suctioning was significantly different in both groups. Whereas the PaO2 returned to the initial value within 2 min after conventional suctioning, we found a decrease in PaO2 in the bronchoscopic group even after 15 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Efficient atraumatic liquid suction by means of slit suction tubes combined with a pressure control unit.

In 1976 a modified suction system for neurosurgery and precision surgery was presented. It was developed to meet the need for efficient and atraumatic liquid suction. the system consists of suction tube ends provided with three vertical slits in the suction edge (W-tubes), a Pressure Control Unit (PCU) and an independent suction pump with an air capacity of 25-30 litres per min. This system has subsequently been modified for microsurgery. The PCU normally controls the negative pressure to 20 kPa (corresponding to 200 cm of water) for atraumatic suction of liquid, which is needed during most of the operating time. For suction of various tissues or cleaning the system, the surgeon can set the pressure limit to 50 or 90 kPa by means of a foot-operated IR-transmitter in a pedal with a kick-down function. The PCU and the W-tubes, which neutralize the pressure load on tissue and the sudden interruption of liquid flow that are inevitable with conventional suction tips, form a system with a high liquid suction capacity in spite of the atraumatic suction pressure. This is possible because the slits maintain a large active suction area. Crushed or soft tissues and coagulated blood are aspirated as and when required, if necessary by elevation of the negative pressure limit. The W-tubes are not provided with an air inlet hole on the tube because that method of pressure control proved unpredictable and variable and reduced the suction capacity by interfering with the flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Neurosurgery↗
PubMed2003

Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: a prospective randomised controlled trial.

STUDY OBJECTIVE: Endotracheal suctioning in intubated patients is routinely applied in most ICUs but may have negative side effects. We hypothesised that on-demand minimally invasive suctioning would have fewer side effects than routine deep endotracheal suctioning, and would be comparable in duration of intubation, length of stay in the ICU, and ICU mortality. DESIGN: Randomised prospective clinical trial. SETTING: In two ICUs at University Hospital Groningen, the Netherlands. PATIENTS: Three hundred and eighty-three patients requiring endotracheal intubation for more than 24 h. INTERVENTIONS: Routine endotracheal suctioning (n=197) using a 49-cm suction catheter was compared with on-demand minimally invasive airway suctioning (n=186) using a suction catheter only 29 cm long. MEASUREMENTS AND RESULTS: No differences were found between the routine endotracheal suctioning group and the minimally invasive airway suctioning group in duration of intubation [median (range) 4 (1-75) versus 5 (1-101) days], ICU-stay [median (range) 8 (1-133) versus 7 (1-221) days], ICU mortality (15% versus 17%), and incidence of pulmonary infections (14% versus 13%). Suction-related adverse events occurred more frequently with RES interventions than with MIAS interventions; decreased saturation: 2.7% versus 2.0% (P=0.010); increased systolic blood pressure 24.5% versus 16.8% (P<0.001); increased pulse pressure rate 1.4% versus 0.9% (P=0.007); blood in mucus 3.3% versus 0.9% (P<0.001). CONCLUSIONS: This study demonstrated that minimally invasive airway suctioning in intubated ICU-patients had fewer side effects than routine deep endotracheal suctioning, without being inferior in terms of duration on intubation, length of stay, and mortality.

Cost-Benefit Analysis↗
PubMed1990

Incidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using a Trach Care closed-suction system versus an open-suction system: prospective, randomized study.

Eighty-four intubated, mechanically ventilated patients were prospectively evaluated for incidences of colonization and nosocomial pneumonias dependent on whether they received endotracheal suctioning by an "open" suction method vs. "closed" suction (Trach Care Closed Suction System) method. Results show that closed suctioning is associated with a significant (67% vs. 39% p less than .02) increase in colonization compared with open suctioning. However, difference in the incidence of nosocomial pneumonia was not significantly (26% vs. 29%) different between closed and open suctioning. Differences in severity of illness (Acute Physiology and Chronic Health Evaluation II and Therapeutic Intervention Scoring System), age, sex, presence of NG tubes, use of H2 antagonists or antacids, use of antibiotics, and history of smoking were all nonsignificant. Survival analysis demonstrated that the probability of survival without developing nosocomial pneumonia was greater among closed-suctioning patients vs. open-suctioned patients (p less than .03). This study shows that suctioning performed via the Trach Care closed-suction system increases the incidence of colonization but not the incidence of nosocomial pneumonia, and may actually decrease mortality when compared with open-suction systems.

Adolescent↗
PubMed2000

[Ultrasonic aspirator with controllable suction system--variable action suction adapter and clinical experience with it].

While the ultrasonic aspirator (UA) has been widely used as one of the indispensable tools in the field of neurosurgery, a potential risk when using the present UA is injury to the neurovascular structures due to ultrasonic pulverization and constant forceful suction power. We have devised a small variable action suction adapter that can be used in a similar manner to conventional surgical suction tubes. The UA control unit and the handpiece used in this study were the Sonopet UST-2000 and HA-01, respectively (M & M Corporation Tokyo, Japan). The handpiece is slim, with the mid-portion diameter of 13 mm, and it weighs 100 grams. A variable action suction adapter was made from polycarbonate of 15 x 12 x 13 mm in size. The adapter was connected to the suction tube using a Y-shaped connector (Fig. 2 A), which was integrated into the handpiece. The suction power is regulated by variably closing the oval-shaped hole. The adapter can be variously placed on and rotated around the handpiece (Fig. 2 B and C) so that either the right or left hand handles it in a similar fashion to conventional suction tubes. We used this UA in surgery for 8 patients with large brain tumors (meningioma in 5 cases, metastatic brain tumor in 2 cases and glioma in one case). It reduced the risk of suction-related injury to the neurovascular structures and was handled in a similar manner to conventional suction tubes. This adapter ensures the complete control of suction power, which will reduce the risk of suction injury.

Evaluation Studies as Topic↗
PubMed1995

[Special suction tube holder for a laser handpiece in effective smoke suction evacuation. On the problem of smoke suction in external CO2 laser therapy].

Treatment with a CO2 laser causes high smoke production, which leads to reduced view to the surgical field, to bad smell and has potential health hazards. Hitherto the problem of the external smoke evacuation had not been solved sufficiently. Therefore a special sucking-tube holder for a laser handpiece is presented. The end of the sucking tube exactly follows all movements of the handpiece and can be positioned close to the source of smoke. Through a defined angle the smoke can be removed quickly out of the way of the laser beam. According to the practical experiences so far, this special equipment on a laser handpiece guarantees an effective evacuation of smoke, allows the reduction of assisting staff, reduces irritation through bad smell and additionally minimizes the potential risks of smoke caused by an external CO2 laser application.

Condylomata Acuminata↗
PubMed2000

Setting safe and effective suction pressure: the effect of using a manometer in the suction circuit.

OBJECTIVES: To establish the levels of pressure used to perform tracheal suction (TS) and if they are affected by having a manometer visible in the suction circuit. DESIGN: A bench test evaluation of simulated tracheal suction. SETTING: Physiotherapy department of a major teaching hospital in Melbourne, Australia. PARTICIPANTS: Sixty-four nurses and physiotherapists who regularly apply TS to patients in the intensive care units of this hospital. INTERVENTIONS: All subjects used both circuit A (without a visible manometer) and B (with a visible manometer) in a predetermined random order. For both, subjects adjusted the suction control tap to where they said a safe and effective pressure (set pressure) was delivered and then occluded the suction catheter as though suctioning (applied pressure). Subjects then completed a questionnaire on their current TS practise. MEASUREMENTS AND RESULTS: All set pressures (mean = 228.57 mmHg) and all applied pressures (mean = 359. 52 mmHg) were significantly higher (P <.001) when compared to the expected pressures (mean = 135 mmHg). Pressures set without a visible manometer (circuit A) were significantly higher (P <.05) than those using a visible manometer (circuit B) but the applied pressures were not significantly different (P =.166). Neither the investigator (P =.618) or the test order (P =.167) had a significant effect on the outcome. Questionnaire results showed 31 % of subjects considered 100-170 mmHg a safe and effective suction pressure whilst none reported using an objective means of measuring pressure. CONCLUSION: All pressures in both circuits were significantly higher than those recommended as safe in the literature. In addition, pressures were unaffected by the inclusion of a visible manometer in the suction circuit.

Adult↗
PubMed2005

Oronasopharyngeal suction versus no suction in normal and term infants delivered by elective cesarean section: a prospective randomized controlled trial.

BACKGROUND/AIM: There are controversies about the routine use of oronasopharyngeal suction (ONPS) in healthy infants. This study aimed to compare the effects of oronasopharyngeal suction with those of no suction in normal, term infants delivered by cesarean section. METHODS: 140 term, healthy newborns of uncomplicated pregnancies were prospectively randomized to one of two groups according to the use of ONPS procedure. Differences in oxygen saturation levels, heart rates, and Apgar scores were determined. RESULTS: The mean SaO(2) values through the 2nd and 6th min of life were significantly higher in the no suction group (p < 0.001). The maximum time to reach SaO(2) of > or =92% (6 vs. 11 min) and > or =86% (5 vs. 8 min) saturation were shorter in the no suction group than in the ONPS group. The mean heart rates were consistently and significantly lower in the no suction group during the first 6 min except the second one. All neonates without suction had an Apgar score of 10 at the 5th min, while the mean +/- SD for ONPS group was 9.34 +/- 0.48 (p < 0.001). CONCLUSION: Although findings remained on statistical level and did not lead to clinically adverse outcomes, there is no statistical or physiological basis for oronasopharyngeal suction as a systematic procedure in healthy, term infants delivered by cesarean section.

Adult↗
PubMed2005

Cranial movements during suction feeding in teleost fishes: Are they modified to enhance suction production?

Suction is produced during prey capture by most teleost fishes. Here, we ask two questions about the functional basis of suction feeding. First, is there variation in the kinematic pattern produced by different species while suction feeding? Second, do species termed 'suction specialists' demonstrate similar modifications to their feeding behavior? We used 10 kinematic variables in a principal component analysis to identify axes of variation among 14 suction feeding teleost species (representing nine families and five orders within the Euteleostei) that demonstrate different feeding habits and habitats. MANOVA and Tukey post hoc tests were used to assess differences among species. Most species clustered together on the principal component axes, suggesting a generalized mechanism that facilitates unidirectional flow. Typically, only one species stood out as 'extreme' on each functional axis, and a species that stood out on one axis did not stand out on others. Only one species, the flatfish Pleuronichthys verticalis, an obligate benthic feeder, demonstrated modifications consistent with enhanced suction production. This species displayed a suite of changes that should enhance suction production, including large hyoid depression, large cranial rotation, and small gape. We suggest that suction performance may be greatest in such obligate benthic feeders because cranial morphology is highly modified and prey are captured from the substrate.

Analysis of Variance↗
PubMed2005

A prospective randomized controlled trial of suction versus non-suction to the under-water seal drains following lung resection.

OBJECTIVE: Practice varies as to whether or not suction is applied to under-water seal drains following lung surgery. We tested the null hypothesis that there is no difference with respect to air leak duration. METHODS: Patients undergoing thoracotomy or video assisted thoracoscopic surgery for lobectomy or wedge resection had either low-pressure suction or no suction applied to their underwater seal bottles postoperatively. Patients were allocated using minimization, a method of unbiased allocation ensuring balance between the arms of a trial with respect to known or suspected confounding factors. The trial was powered for duration of air leak. If an air leak persisted on the 7th post-operative day, the surgeon determined further management. Kaplan-Meier survival analysis of air leak duration and a log rank test were performed on an intention-to-treat basis, with observations censored at 144h (6 complete days). RESULTS: Of the 254 patients that entered the trial, data were available for analysis for 239 (123 no-suction and 116 suction). There was no significant difference in the cumulative persistence of air leaks between the two groups (P=0.62) and inspection of the Kaplan-Meier curves suggests that any difference is negligible. CONCLUSIONS: Applying suction to the underwater seal drains following lung surgery makes no difference in terms of air leak duration. In the light of this finding we have adopted a uniform policy of no suction being applied to the underwater seal, from the time of surgery, unless a specific clinical judgment is made to use it. The anticipated gains are that this will reduce work and cost and aid mobilization.

Adult↗
PubMed2001

Warning! Suctioning. A lung model evaluation of closed suctioning systems.

BACKGROUND: Closed system suctioning, CSS, has been advocated to avoid alveolar collapse. However, ventilator manufacturers indicate that extreme negative pressure levels can be obtained during closed system suctioning, impeding the performance of the ventilator. METHODS: Suctioning with a 12 or 14 Fr catheter with a vacuum level of -50 kPa was either performed with an open technology or a CSS, where the catheter is introduced through a tight-fitting connection through the endotracheal tube, EYT. The lung model was ventilated with a Servo 900C or 300 ventilator with an I:E ratio of 1:2, 1:1 and 2:1 and extrinsic positive end-expiratory pressure (PEEP) at 0 or 10 cm H20. Respiratory volumes and alveolar pressure were measured at the lung model alveolus. RESULTS: The initial suctioning flow was >40 l/min with a 14 Fr catheter. When inserting the catheter through a no. 7 ETT, PEEP rose from 11 to 23 cm H2O during volume control ventilation with an I:E ratio 1:1. During suctioning the alveolar pressure fell to 10 cm H2O below the set PEEP level. CSS during pressure control ventilation had fewer effects. Low tidal volumes, inverse I:E ratio and secretions in the tube resulted in pressures down to -92 cm H2O. CONCLUSION: CSS should not be used in volume control ventilation due to risk of high intrinsic PEEP levels at insertion of the catheter and extreme negative pressures during suctioning. Pressure control ventilation produces less intrinsic PEEP effect. The continuous positive airway pressure (CPAP) mode offers the least intrinsic PEEP during insertion of the catheter and least sub-atmospheric pressure during suctioning.

Air Pressure↗
PubMed1993

Controlled trial of a continuous irrigation suction catheter vs conventional intermittent suction catheter in clearing bronchial secretions from ventilated patients.

Continuous irrigation-suction catheter (Irri-cath) is a double-lumen device that allows for simultaneous saline solution infusion and aspiration. This system may theoretically be more effective than conventional dry intermittent suction due to its vortex principle. To test this hypothesis, we performed 200 suction maneuvers in 20 ventilated patients. Identically shaped catheters were used in a randomized sequence. For the same individual, we used equal instilled saline solution volume (40 ml), vacuum pressure (-180 cm H2O), and ventilatory parameters. Effectiveness of suction was determined by measuring the total aspirated volume, the dry lyophilized weight of secretion, the corrected dry weight (dry weight-weight of instilled salt), and protein concentration. No difference in heart rate, respiratory frequency, O2 saturation, systemic blood pressure, peak inspiratory pressure, or patient discomfort was found when the two modalities were compared; however, the total volume of secretions collected, the dry weight, the corrected dry weight, and the protein concentration were significantly higher with continuous irrigation suction catheter when compared with the conventional method (p < 0.05). The suction time was shorter with the Irri-cath (p < 0.05). We conclude that the Irri-Cath is more effective than conventional intermittent suction catheter in clearing bronchial secretions in patients on mechanical ventilation.

Bronchi↗
PubMed1992

Nasogastric tube "suction-buster holes" release mucosal occlusion despite high suction.

Aspiration devices can persistently malfunction if moderate (not just high) suction causes mucosal occlusion of every opening. The standard pattern of uniformly large orifices was modified by supplementing half the nasal tubes with smaller (one tenth of the area) openings. Ten pairs of postoperative patients sipped water while suction applied to their nasal tubes varied from 40 to 300 mm Hg. Unmodified tubes consistently functioned only when applied vacuum was below 60 mm Hg. At 60 mm Hg, 20% (2/10) of tubes malfunctioned, with swallows failing to return on three consecutive attempts even at this gentle level. The failure rate rose with increasing applied suction. All 10 devices evidenced persistent occlusion when the vacuum exceeded 90 mm Hg. Each adverse result was confirmed by continued malfunction when suction was increased by another 10 mm Hg. The brisk flow through large esophageal openings dramatically differs from restricted inflow. Supplementing the standard set of uniform, large-bore aspiration orifices with additional small openings results in unimpeded function over the full range of available hospital vacuum. The additional small openings permitted the turbulent evacuation characteristic of large-bore patency. No device with accessory "suction-buster" orifices malfunctioned at even the highest available suction (300 mm Hg).

Cholecystectomy↗
PubMed1985

Reduction suction mammoplasty and suction lipectomy as an adjunct to breast surgery.

Suction lipectomy has become an accepted procedure and its full use is still being elucidated. The author herein describes the use of suction lipectomy as an adjunct in refining the results of established surgical procedures on the breast. The authors also explain the use of suction lipectomy in doing "suction reduction" mammoplasty. The advantages of the use of suction lipectomy as an adjunct to breast surgery and for reduction mammoplasty are explained.

Adipose Tissue↗
PubMed2003

Effectiveness of oxygenation and suction in cataract surgery: is suction of CO2-enriched air under the drape during cataract surgery necessary?

PURPOSE: To investigate the effectiveness of aspiration of expired air by a suction system on peripheral oxygen saturation (SpO(2)) and end tidal carbon dioxide (EtCO(2)) during cataract surgery. MATERIALS AND METHODS: In total, 160 pre-medicated patients aged between 40 and 70 years (ASA I-III, classification of patients according to the American Society of Anesthesiologists) scheduled for cataract surgery under retrobulbar or peribulbar block were examined in a randomised, single-blind manner. The patients were sedated with 3 mg midazolam i.v. 15 min before operation and were monitored with an anaesthesia monitor. Heart rate (HR), non-invasive mean arterial pressure (MAP), SpO(2) and EtCO(2) were continuously measured using a standardised monitor. The first group (non-suction group, n = 80) received 4 L min(-1) O(2) with nasal cannule while the second group (suction group, n = 80) received 4 L min(-1) O(2) with nasal cannule, and the expired air was aspired with a Y-piece suction system. EtCO(2) was measured with the line of the sampling tube in the anaesthesia monitor. Respiratory rate (RR) was counted for a period of 1 min at each measurement time with thoracic excursions. The results were evaluated by unpaired t-test and analysis of variance. RESULTS: Severe reduction of SpO(2) and raising of EtCO(2) were observed significantly in the first group during the operation. RR, HR and MAP increased due to hypoxaemia. In the second group, SpO(2) was stabilised at high levels and EtCO(2) did not increase. RR, HR and MAP levels remained within the normal limits. Differences between the two groups were statistically significant (P < 0.05). CONCLUSION: During cataract surgery with local anaesthesia, SpO(2) decreases and RR, HR and MAP increase because of reinspiration of expired air under the drape. Insufflation of O(2) and aspiration of expired air with a suction system have prevented severe reduction of SpO(2) and raising of EtCO(2). It was suggested that O(2) delivery and use of an aspiration system decreased the risk of hypoxaemia significantly in the patients undergoing the cataract surgery.

Adult↗
PubMed1982

Catheter drainage of spontaneous pneumothorax: suction or no suction, early or late removal?

Twenty-three patients with primary spontaneous pneumothorax and 30 patients with secondary spontaneous pneumothorax treated by intercostal catheter drainage with underwater seal were divided randomly into two groups, one receiving suction drainage (up to 20 cm H2O pressure) and the other no suction. The success rate was 57% for the former and 50% for the latter. The suction group spent an average of five days in hospital, whereas the non-suction group averaged four days. Suction drainage therefore did not have any advantage. To determine how soon the catheter could be removed without complication, patients were also divided randomly into two subgroups--one had the catheter removed, without previous clamping, as soon as the lung was expanded; the other had the catheters left in situ for a further three days. The success rate was 52% for the former, and 53% for the latter. But most of the failure in the early removal group was caused by re-collapse of the lung rather than persistent air leakage; hence removal of the catheter too early was not recommended.

Adolescent↗