End-expiratory lung volume recovers more slowly after closed endotracheal suctioning than after open suctioning : a randomized crossover study

Corley, Amanda, Spooner, Amy J., Barnett, Adrian G., Caruana, Lawrence R., Hammond, Naomi E., & Fraser, John F. (2012) End-expiratory lung volume recovers more slowly after closed endotracheal suctioning than after open suctioning : a randomized crossover study. Journal of Critical Care, 27(6), 742.e1-742.e7.

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Purpose Endotracheal suctioning causes significant lung derecruitment. Closed suction (CS) minimizes lung volume loss during suction, and therefore, volumes are presumed to recover more quickly postsuctioning. Conflicting evidence exists regarding this. We examined the effects of open suction (OS) and CS on lung volume loss during suctioning, and recovery of end-expiratory lung volume (EELV) up to 30 minutes postsuction.

Material and Methods Randomized crossover study examining 20 patients postcardiac surgery. CS and OS were performed in random order, 30 minutes apart. Lung impedance was measured during suction, and end-expiratory lung impedance was measured at baseline and postsuctioning using electrical impedance tomography. Oximetry, partial pressure of oxygen in the alveoli/fraction of inspired oxygen ratio and compliance were collected.

Results Reductions in lung impedance during suctioning were less for CS than for OS (mean difference, − 905 impedance units; 95% confidence interval [CI], − 1234 to –587; P < .001). However, at all points postsuctioning, EELV recovered more slowly after CS than after OS. There were no statistically significant differences in the other respiratory parameters.

Conclusions Closed suctioning minimized lung volume loss during suctioning but, counterintuitively, resulted in slower recovery of EELV postsuction compared with OS. Therefore, the use of CS cannot be assumed to be protective of lung volumes postsuctioning. Consideration should be given to restoring EELV after either suction method via a recruitment maneuver.

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2 citations in Web of Science®

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ID Code: 55839
Item Type: Journal Article
Refereed: Yes
Keywords: intensive care, lung
DOI: 10.1016/j.jcrc.2012.08.019
ISSN: 0883-9441
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CLINICAL SCIENCES (110300) > Intensive Care (110310)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Public Health & Social Work
Copyright Owner: Copyright 2012 W.B. Saunders
Deposited On: 19 Dec 2012 05:17
Last Modified: 07 Jan 2013 15:09

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