Effects of Endotracheal Suctioning With Expiratory Pause in Infants.

BACKGROUND

Endotracheal suctioning is a routine procedure in the pediatric ICU (PICU) and can be performed via open or closed systems. Closed-system suctioning has benefits for pressure maintenance in the ventilatory system and oxygen supply during the technique but is less effective. The association of an expiratory pause in closed-system suctioning is an alternative technique. We sought to evaluate the volume of suctioned secretions, respiratory mechanics, and hemodynamic parameters during closed endotracheal suctioning with expiratory pause, compared with conventional closed suctioning.

METHODS

A randomized crossover pilot trial with infants receiving invasive mechanical ventilation >24 h, with neuromuscular blocker, without cough reflex, randomized to define the order of suctioning techniques (T1-technique 1 conventional suctioning without expiratory pause; T2-technique 2: with expiratory pause), performed with a 2-h interval. Evaluated hemodynamic parameters (heart rate, blood pressure, and peripheral arterial oxygen saturation), respiratory mechanics (static and dynamic compliance, inspiratory and expiratory resistance, driving pressure), and suctioning secretion were weighed on a precision balance. Shapiro-Wilk test for normally distributed variables analysis and generalized estimating equation for effect analysis.

RESULTS

Ten infants were included with a median age of 2 months (1.0-3.7). The amount of secretions from the technique with expiratory pause was significantly higher compared with conventional suctioning (mean 1.4 g vs 1.1 g; P < .001). Treatment effect was observed in the analysis of driving pressure (P < .001) and inspiratory resistance (P = .02), with an increase in these variables after suctioning with expiratory pause. There were no significant differences in hemodynamic variables.

CONCLUSIONS

The closed-system suctioning with expiratory pause was more effective in secretion removal compared with conventional closed suctioning. However, driving pressure and inspiratory resistance increased after suctioning with an expiratory pause.