IngentaConnect A comparison of the effectiveness of open and closed endotracheal...

Authors: Copnell, Beverley¹; Tingay, David; Kiraly, Nicholas; Sourial, Magdy; Gordon, Michael; Mills, John; Morley, Colin; Dargaville, Peter

Source: Intensive Care Medicine, Volume 33, Number 9, September 2007 , pp. 1655-1662(8)

Publisher: Springer

Abstract:

To compare the effectiveness of open and closed endotracheal suction in recovering thin and thick secretions in normal and injured lungs during conventional and high frequency ventilation.

Randomised study in a paediatric intensive care model in the animal research laboratory of a tertiary paediatric hospital.

16 New Zealand White rabbits.

Anaesthetised animals were intubated with a 3.5-mm endotracheal tube. Simulated thin and thick secretions (iopamidol 2ml, a watery radio-opaque fluid, and fluorescent mucin 1ml) were instilled in turn 1cm below the tube tip through a catheter placed via a tracheostomy. Open or closed suction, randomly assigned, was applied for 6s at −140mmHg using a 6-F gauge catheter. Following lung injury with repeated saline lavage the procedure was repeated on conventional and high frequency ventilation.

Iopamidol recovery was determined by digitally subtracting the post-contrast and post-suction radiographic images. Mucin recovery was determined by fluorescence assay of the aspirate. In the normal lung similar amounts were recovered by both suction methods. In the lavaged lung closed suction recovered less iopamidol during conventional (22±7.5%) and high frequency ventilation (11±2.4%) than open suction (36±12% and 22±8.1%, respectively). Mucin recovery was less with closed suction during conventional (32±28μl) and high frequency ventilation (30±31μl) than with open suction (382±235μl and 241±153μl).

In the injured lung closed suction was less effective than open suction at recovering thin and thick simulated secretions, irrespective of ventilation mode.

Keywords: Suction; Intubation, intratracheal; Respiration, artificial; High frequency ventilation; Pediatric intensive care

Document Type: Research article

DOI: 10.1007/s00134-007-0635-x

Affiliations: 1: Email: bev.copnell@rch.org.au

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A comparison of the effectiveness of open and closed endotracheal suction