Can ventilator settings reduce the negative effects of endotracheal suctioning? Investigations in a mechanical lung model

BMC Anesthesiology

Research Article

Helge Opdahl¹  Fridtjof Heyerdahl¹  Espen R. Nakstad²  Fredrik Borchsenius³  Ole H. Skjønsberg⁴ 

[1] Department of Acute Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway;Department of Acute Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway;Department of Pulmonary Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway;Department of Pulmonary Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway;Department of Pulmonary Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway;University of Oslo, Oslo, Norway;

关键词: Endotracheal suctioning;    Airway pressure;    Peak pressure;    End-expiratory pressure;    Bronchoscopic suctioning;    Closed Catheter System;    High frequency trigging;    Pressure Controlled Ventilation;    Volume Controlled Ventilation;    AutoPEEP;    Ventilator;   

DOI  :  10.1186/s12871-016-0196-z

 received in 2015-06-27, accepted in 2016-05-13,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe insertion of suction devices through endotracheal tubes (ETTs) increases airway resistance and the subsequent suctioning may reduce airway pressures and facilitate atelectasis.The aim of this study was to investigate how airway pressures and tidal volumes change when different combinations of suction equipment and ETT sizes are used, and to what extent unfavorable effects can be ameliorated by choice of ventilator settings.MethodsA mechanical ventilator was connected to a lung model by ETTs of 9 mm, 8 mm or 7 mm internal diameter (ID) with a pressure transducer inserted distal to the ETT. The effects of suction procedures with bronchoscope and closed catheter systems were investigated during pressure controlled ventilation (PCV) and volume controlled ventilation (VCV). In each mode, the effects of changes in inspiration:expiration (I:E) ratio, trigger sensitivity and suction pressure were examined.ResultsThe variables that contributed most to negative model airway pressures and loss of tidal volume during suctioning were (in descending order); 1) Small-size ETTs (7–8 mm ID) combined with large diameter suction devices (14–16 Fr); 2) inverse I:E ratio ventilation (in VCV); 3) negative ventilator trigger sensitivity; and 4) strong suction pressure. The pressure changes observed distal to the ETTs were not identical to those detected by the ventilator.ConclusionsNegative model airway pressure was induced by suctioning through small-size ETTs. The most extreme pressure and volume changes were ameliorated when conventional ventilator settings were used, such as PCV mode with short inspiration time and a trigger function sensitive to flow changes.

【 授权许可】

CC BY   
© Nakstad et al. 2016