scholarly journals Closed Endotracheal Suctioning Impact on Ventilator-Related Parameters in Obstructive and Restrictive Respiratory Systems: A Bench Study

2021 ◽  
Vol 11 (11) ◽  
pp. 5266
Author(s):  
Fang Jung ◽  
Shang-Shing P. Chou ◽  
Shih-Hsing Yang ◽  
Jau-Chen Lin ◽  
Guey-Mei Jow
Keyword(s):  
Endotracheal Tube ◽  
Peak Inspiratory Pressure ◽  
Lung Compliance ◽  
Minute Volume ◽  
Lung Mechanics ◽  
Suction Catheter ◽  
Pulmonary Mechanics ◽  
Outer Diameter ◽  
Endotracheal Suctioning ◽  
Pulmonary Mechanic

A closed suctioning system (CSS) in patients with coronavirus disease 2019 (COVID-19) prevents spraying respiratory secretions into the environment during suction. However, it is not clear whether ventilation is maintained during the suction procedure, especially in patients with compromised pulmonary mechanics. This paper determines the effects of endotracheal tube (ETT) size, suction catheter size, and two lung mechanics (resistance and compliance) on ventilator-related parameters measured during suction. Suction was performed on an adult training lung, ventilated with either volume-controlled (VC-CMV) or pressure-controlled mandatory ventilation (PC-CMV), using ETT sizes of 6.5–8.0 mm paired with suction catheter sizes of 8–14 French (Fr). Peak inspiratory pressure (PIP) increased by 50% when the ETT’s ventilation area was less than 25 mm2 in size, especially in patients with high airway resistance ventilated with VC-CMV. Positive end-expiratory pressure (PEEP) levels significantly decreased when using 14 Fr SC during VC-CMV and fewer effects during PC-CMV. Change of expiratory minute volume increased with higher outer diameter of suction catheters and decreased with severe lung compliance during PC-CMV. The change in ventilator-related parameters were intently monitored in the patient whose pulmonary mechanic was compromised through the CSS endotracheal tube suctioning procedures in clinical airway management.

scholarly journals Optimizing effects on airway pressure and minute volume during closed endotracheal suctioning: a simulated lung model

SIMULATION ◽  
2021 ◽  
pp. 003754972110061
Author(s):  
Fang Jung ◽  
Shang-Shing P Chou ◽  
Shih-Hsing Yang ◽  
Jau-Chen Lin ◽  
Guey-Mei Jow
Keyword(s):  
Airway Pressure ◽  
Clinical Signs ◽  
Peak Inspiratory Pressure ◽  
Minute Volume ◽  
Lung Model ◽  
Suction Catheter ◽  
Endotracheal Suctioning ◽  
Suction System ◽  
Volume Controlled ◽  
Selection Of

A closed suction system is used to remove endotracheal secretions without interrupting the patient’s ventilation. Closed suctioning may reduce adverse effects associated with suctioning with, for example, decreased clinical signs of hypoxemia and limited environmental, personnel, and patient contamination. However, it is not clear whether ventilation is maintained during the procedure. We aimed to determine the effects of endotracheal tube (ETT) size, suction catheter (SC) size, and SC length in the ETT on ventilation parameters measured during suction. Suction was performed on a test lung, ventilated with either volume-controlled continuous mandatory ventilation (VC-CMV) or pressure-controlled continuous mandatory ventilation (PC-CMV) using ETT sizes of 6.0–8.5 mm paired with SC sizes of 8–16 French gauge (Fr = 0.33 mm). Airway resistance ( Raw), peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), and expiratory minute volume ( Vexp) were recorded for each ventilation episode by a HAMILTON-G5 ventilator. Here, Raw was considerably increased by insertion of the SC into the ETT. This Raw effect altered the PIP and Vexp. PIP was increased in VC-CMV because the ventilation area of the ETT was reduced, and Vexp was decreased in PC-CMV in relation to the size of the SC. PEEP decreased with application of the 16 Fr SC and 30 L/min flow rate in VC-CMV. We conclude that airway pressure and minute volume are not maintained during closed endotracheal suctioning with VC-CMV and PC-CMV, respectively. The degree of interference to ventilation is affected through selection of appropriate SC size and ventilation settings.

Development of stability of the respiratory system in preterm infants

1988 ◽  
Vol 65 (1) ◽  
pp. 441-444 ◽  
Author(s):  
G. P. Heldt
Keyword(s):  
Chest Wall ◽  
Preterm Infants ◽  
Pulmonary Ventilation ◽  
Lung Compliance ◽  
Minute Volume ◽  
Lung Mechanics ◽  
Diaphragmatic Function ◽  
Postconceptional Age ◽  
Intraesophageal Pressure ◽  
Dynamic Lung Compliance

Chest wall distortion leads to increased minute volume displacement of the diaphragm (MVDD) and diaphragmatic work (DW) in preterm infants. Lung mechanics, MVDD, and DW were measured at weekly intervals in six preterm infants between 29 and 36 wk postconceptional age. Over the period of study, MVDD and DW decreased significantly, whereas dynamic lung compliance consistently increased. There was no consistent change in the pulmonary ventilation, total pulmonary resistance, the work performed on the lungs, or the change in intraesophageal pressure with tidal breathing. The improvement in the stability of the chest wall, as indicated by the change in these dynamic measurements of diaphragmatic function, parallels the decrease in static chest wall compliance and the clinical course of the resolution of apnea of prematurity.

Using Conventional Infant Ventilators at Unconventional Rates

PEDIATRICS ◽  
1984 ◽  
Vol 74 (4) ◽  
pp. 487-492 ◽  
Author(s):  
Stephen J. Boros ◽  
Dennis R. Bing ◽  
Mark C. Mammel ◽  
Erik Hagen ◽  
Margaret J. Gordon
Keyword(s):  
Tidal Volume ◽  
Airway Pressure ◽  
Important Determinant ◽  
Peak Inspiratory Pressure ◽  
Lung Compliance ◽  
Minute Volume ◽  
Inspiratory Pressure ◽  
Positive End Expiratory Pressure ◽  
Inspiratory Time ◽  
Pressure Monitor

The effect of progressive increases in ventilator rate on delivered tidal and minute volumes, and the effect of changing peak inspiratory pressure (Pmax), positive end-expiratory pressure (PEEP), and inspiration to expiration (I:E) ratio at different ventilator rates were examined. Five different continuous-flow, time-cycled, pressure-preset infant ventilators were studied using a pneumotachograph, an airway pressure monitor, and a lung simulator. As rates increased from 10 to 150 breaths per minute, tidal volume stayed constant until 25 to 30 breaths per minute; then progessively decreased. In all, tidal volume began to decrease when proximal airway pressure waves lost inspiratory pressure plateaus. As rates increased, minute volume increased until 75 breaths per minute, then leveled off, then decreased. Substituting helium for O2 increased the ventilator rate at which this minute volume plateau effect occurred. Increasing peak inspiratory pressure consistently increased tidal volume. Increasing positive end-expiratory pressure decreased tidal volume. At rates less than 75 breaths per minute, inspiratory time (inspiration to expiration ratio) had little effect on delivered volume. At rates greater than 75 breaths per minute, inspiratory time became an important determinant of minute volume. For any given combination of lung compliance and airway resistance: (1) there is a maximum ventilator rate beyond which tidal volume progressively decreases and another maximum ventilator rate beyond which minute volume progressively decreases; (2) at slower rates, delivered volumes are determined primarily by changes in proximal airway pressures; (3) at very rapid rates, inspiratory time becomes a key determinant of delivered volume.

Effects of fever on pulmonary diffusing capacity and pulmonary mechanics in man

1963 ◽  
Vol 18 (6) ◽  
pp. 1065-1070 ◽  
Author(s):  
Leon Cander ◽  
Ernest G. Hanowell
Keyword(s):  
Pulmonary Blood Flow ◽  
Minute Volume ◽  
Lung Mechanics ◽  
Breath Holding ◽  
Pulmonary Mechanics ◽  
Diffusing Capacity ◽  
Oral Temperature ◽  
Pulmonary Resistance ◽  
Pulmonary Diffusing Capacity ◽  
Normal Adults

Measurements of oral temperature, pulse rate, blood pressure, expired minute volume (Ve), respiratory rate (f), O2 consumption (Vo2), CO2 excretion (Vco2), breath-holding pulmonary diffusing capacity (DlCO), dynamic pulmonary compliance (Cdyn), and total pulmonary resistance were made on six normal adults before and at regular intervals over an 8-hr period following the induction of fever with triple typhoid vaccine. Although Ve, f, Vo2 increased during the chill, flush, and defervescence phases of fever, there was no significant change in Cdyn and total pulmonary resistance. Of interest was the slight, though statistically significant decrease in DlCO during the flush and defervescence phases. Results suggest a low temperature coefficient for the mechanical properties of the lung in the range studied. The absence of an increased DlCO during the flush phase of fever when Ve and the cardiac output are known to increase suggests that ventilation and pulmonary blood flow are not important determinants of DlCO. lung mechanics; ventilation Submitted on February 18, 1963

On-Line Calculation of Pulmonary Mechanics by Digital Computer

1978 ◽  
Vol 17 (04) ◽  
pp. 261-272 ◽  
Author(s):  
Y. Brault ◽  
G. Atlan ◽  
H. Lorino ◽  
A. Harf ◽  
A.-M. Lorino ◽  
...  
Keyword(s):  
Time Pressure ◽  
Lung Compliance ◽  
Pulmonary Mechanics ◽  
Close Correspondence ◽  
Standard Equipment ◽  
On Demand ◽  
On Line ◽  
The Subject ◽  
Ventilatory Mechanics ◽  
Computerized System

A system was built up around a minicomputer to process in real time pressure and flow signals collected during the course of three ventilatory mechanics tests: the calculation of the lung volume, the evaluation of the static lung compliance, the analysis of the forced expiratory performance. The subject is seated in an open body Plethysmograph, which allows for the instantaneous calculation of changes in the volume of his thorax and abdomen. The system is controlled through a graphics console which displays the sampled curves and the results of data processing. In addition, the signals can be stored on demand onto a magnetic tape so that the method can be tested and improved off line. The results obtained in healthy volunteers are highly reproducible. A close correspondence is found both in patients and volunteers between computer-derived and hand-calculated results. The computerized system has become a standard equipment of our Lung Function Department, where it allows for a rapid quantitative analysis of lung volumes, lung elasticity and bronchial airflow.

Experience With the Illuminated Endotracheal Tube in the Prevention of Unsafe Intubations in the Premature and Full-Term Newborn

PEDIATRICS ◽  
1994 ◽  
Vol 93 (3) ◽  
pp. 389-391
Author(s):  
Richard M. Heller ◽  
Toni W. Heller
Keyword(s):  
Endotracheal Tube ◽  
Chest Wall ◽  
Light Source ◽  
Full Term ◽  
Optimal Placement ◽  
Bright Spot ◽  
Outer Diameter ◽  
Suprasternal Notch ◽  
Thoracic Inlet ◽  
Term Newborns

Objective. To determine whether an endotracheal tube modified by incorporation of a fiberoptic strand in the wall and connected to a light source could be safely and reliably positioned in premature and full-term newborns using transdermal siting of a bright spot on the skin at the suprastemal notch of the chest wall. Methods. All newborns in the Vanderbilt Neonatal Intensive Care Unit who were candidates for intubation by established clinical criteria, who were not already intubated, were candidates for the study. We defined optimal placement of the endotracheal tube to be one with the tip of the tube below the first thoracic vertebral body and no less than 0.5 cm above the carina or at T-4 (if the carina could not be seen on the radiograph). A light source was connected to the fiberoptic strand and the endotracheal tube positioned so that a circle of light was visible on the skin of the chest wall at the suprasternal notch. Results. In all 22 placements, the tube tip was below the larynx and above the canina. In 20 of the placements, the position was optimal between T-1 and T-4, whereas in the other 2 the tube tip was high between the larynx and the thoracic inlet. This system required that an endotracheal tube 0.5 mm smaller than usually used be utilized because of the slight increase in outer diameter due to the fiberoptic strand. Conventional suction catheters were used in this study. Conclusions. This study has shown that the illuminated endotracheal tube is a reliable device for accurate positioning in premature and full-term newborns using transdermal siting of a bright spot on the skin at the suprasternal notch.

The Effect of Posture on Ventilation and Lung Mechanics in Preterm and Light-for-Date Infants

PEDIATRICS ◽  
1979 ◽  
Vol 64 (4) ◽  
pp. 429-432 ◽  
Author(s):  
Alastair A. Hutchison ◽  
Keith R. Ross ◽  
George Russell
Keyword(s):  
Tidal Volume ◽  
Prone Position ◽  
Supine Position ◽  
Work Of Breathing ◽  
Newborn Infants ◽  
Lateral Position ◽  
Minute Volume ◽  
Lung Mechanics ◽  
Total Work ◽  
Preterm Group

The effect of right lateral, supine, and prone postures on ventilation and lung mechanics was studied in 23 healthy newborn infants, ten preterm and 13 term, "light-for-date." In the preterm group, tidal volume, minute volume, elastic work, inspiratory viscous work, total viscous work, and the total work of breathing were significantly greater in the prone position than in the supine position. Results obtained in the lateral position did not differ significantly from those in the prone or supine positions. Posture did not significantly affect tidal volume or lung mechanics in the light-for-date infants. The prone position is suggested to be the optimum nursing posture for healthy preterm infants.

AIDS and Suctioning Newborn Infants

PEDIATRICS ◽  
1988 ◽  
Vol 82 (3) ◽  
pp. 520-521
Author(s):  
PAUL M. KEMPEN
Keyword(s):  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Negative Pressure ◽  
Newborn Infants ◽  
Upper Airway ◽  
Suction Catheter ◽  
Meconium Aspiration ◽  
Endotracheal Suction ◽  
Suction Device ◽  
Recommended Therapy

To the Editor.— The current recommended therapy for patients with meconium aspiration consists of extensive suctioning of the oropharynx and nasopharynx after delivery of the head, with subsequent endotracheal intubation and deep suction with the endotracheal tube as the suction catheter. The upper airway is commonly cleared with a bulb syringe and/or a Delee suction device. With both the Delee and the currently recommended endotracheal suction methods, the physician's mouth is the source of negative pressure.

Endotracheal saline and suction catheters: sources of lower airway contamination

1994 ◽  
Vol 3 (6) ◽  
pp. 444-447 ◽  
Author(s):  
DA Hagler ◽  
GA Traver
Keyword(s):  
Critical Care ◽  
Normal Saline ◽  
Catheter Insertion ◽  
Lower Airway ◽  
Suction Catheter ◽  
Endotracheal Suctioning ◽  
Saline Irrigation ◽  
Endotracheal Tubes ◽  
Viable Bacteria ◽  
Saline Instillation

BACKGROUND. Normal saline instillation prior to endotracheal suctioning is a critical care ritual that persists despite a lack of demonstrated benefit. Saline instillation may dislodge viable bacteria from a colonized endotracheal tube into the lower airway, overwhelming the defense mechanism of immunocompromised patients. OBJECTIVE. To determine the extent to which normal saline irrigation and suction catheter insertion dislodge viable bacteria from endotracheal tubes. METHODS. Endotracheal tubes from 10 critical care patients intubated for at least 48 hours were obtained immediately after extubation. Each tube was used in random order for both saline instillation and suction catheter insertion. Dislodged material was cultured for quantitative analysis. RESULTS. Suction catheter insertion dislodged up to 60,000 viable bacterial colonies. A 5-mL saline instillation dislodged up to 310,000 viable bacterial colonies. CONCLUSIONS. The potential for infection caused by dislodging bacteria into the lower airway is additional evidence that routine use of saline during suctioning procedures should be abandoned.

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