Tracheal Secretion Management in the Mechanically Ventilated Patient: Comparison of Standard Assessment and an Acoustic Secretion Detector

Authors: Lucchini, Alberto; Zanella, Alberto; Bellani, Giacomo; Gariboldi, Roberto; Foti, Giuseppe; Pesenti, Antonio; Fumagalli, Roberto

Source: Respiratory Care, Volume 56, Number 5, May 2011 , pp. 596-603(8)

Publisher: The Journal Respiratory Care Company

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Abstract:

BACKGROUND: Standard indications for endotracheal suctioning are often based on clinical judgment on the deterioration of the patient's condition, and/or routine suctioning. TBA Care is a secretion detector that analyses airway sounds and indicates the need for suctioning. OBJECTIVE: To determine the efficacy of TBA Care in detecting retained secretions, compared to standard indications. METHODS: We conducted a prospective randomized trial with 72 general intensive care unit patients randomized at intubation into 2 groups, differing only in suctioning indications. The control group indications were at least 3 scheduled suctionings per day or were clinically driven. The secretion-detector group indications were device signal or clinically driven. At each suctioning session we recorded the indication for suctioning and the amount of secretions removed. Patients were followed until intensive care unit discharge or extubation. Diagnosis of ventilator-associated pneumonia was confirmed via microbiological analysis of suctioned secretions. RESULTS: We analyzed 1,705 suctionings in the control group and 1,354 in the secretion-detector group. The secretion-detector group had fewer suctionings per day (3.9 ± 2.3 vs 4.8 ± 1.2, P = .002) and a lower rate of unnecessary suctionings (4% vs 12%, P < .001). In the secretion-detector group, 97% of the suctionings were performed following the signal from the TBA Care device. In the control group, clinical deterioration (65%) was the most frequent indication for suctioning. The incidence of ventilator-associated pneumonia was similar in the groups. CONCLUSIONS: TBA Care seems to give valid and timely indications for suctioning, anticipating clinical deterioration due to secretion retention and reducing unnecessary suctionings. (ClinicalTrials.gov registration NCT00932776.)

Keywords: endotracheal suctioning; mechanical ventilation; secretion detector; secretion management; ventilator-associated pneumonia

Document Type: Research Article

DOI: http://dx.doi.org/10.4187/respcare.00909

Affiliations: Department of Perioperative Medicine and Intensive Care, San Gerardo Hospital, Monza, Italy

Publication date: May 1, 2011

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