Lung volume changes during cleaning of closed endotracheal suction catheters: a randomized crossover study using electrical impedance tomography

Corley, Amanda, Sharpe, Nicola, Caruana, Lawrence R., Spooner, Amy J. and Fraser, John F. (2014) Lung volume changes during cleaning of closed endotracheal suction catheters: a randomized crossover study using electrical impedance tomography. Respiratory Care, 59 4: 497-503. doi:10.4187/respcare.02601


Author Corley, Amanda
Sharpe, Nicola
Caruana, Lawrence R.
Spooner, Amy J.
Fraser, John F.
Title Lung volume changes during cleaning of closed endotracheal suction catheters: a randomized crossover study using electrical impedance tomography
Journal name Respiratory Care   Check publisher's open access policy
ISSN 0020-1324
1943-3654
Publication date 2014-04-01
Sub-type Article (original research)
DOI 10.4187/respcare.02601
Open Access Status Not Open Access
Volume 59
Issue 4
Start page 497
End page 503
Total pages 7
Place of publication Irving, TX United States
Publisher Daedalus Enterprises
Language eng
Formatted abstract
BACKGROUND: Airway suctioning in mechanically ventilated patients is required to maintain airway patency. Closed suction catheters (CSCs) minimize lung volume loss during suctioning but require cleaning post-suction. Despite their widespread use, there is no published evidence examining lung volumes during CSC cleaning. The study objectives were to quantify lung volume changes during CSC cleaning and to determine whether these changes were preventable using a CSC with a valve in situ between the airway and catheter cleaning chamber.

METHODS: This prospective randomized crossover study was conducted in a metropolitan tertiary ICU. Ten patients mechanically ventilated via volume-controlled synchronized intermittent mandatory ventilation (SIMV-VC) and requiring manual hyperinflation (MHI) were included in this study. CSC cleaning was performed using 2 different brands of CSC (one with a valve [Ballard Trach Care 72, Kimberly-Clark, Roswell, Georgia] and one without [Portex Steri-Cath DL, Smiths Medical, Dublin, Ohio]). The maneuvers were performed during both SIMV-VC and MHI. Lung volume change was measured via impedance change using electrical impedance tomography. A mixed model was used to compare the estimated means.

RESULTS: During cleaning of the valveless CSC, significant decreases in lung impedance occurred during MHI (−2563 impedance units, 95% CI 2213–2913, P < .001), and significant increases in lung impedance occurred during SIMV (762 impedance units, 95% CI 452–1072, P < .001). In contrast, cleaning of the CSC with a valve in situ resulted in non-significant lung volume changes and maintenance of normal ventilation during MHI and SIMV-VC, respectively (188 impedance units, 95% CI −136 to 511, P = .22; and 22 impedance units, 95% CI −342 to 299, P = .89).

CONCLUSIONS: When there is no valve between the airway and suction catheter, cleaning of the CSC results in significant derangements in lung volume. Therefore, the presence of such a valve should be considered essential in preserving lung volumes and uninterrupted ventilation in mechanically ventilated patients.
Keyword Suctioning
Lung volume
Lung volume measurement
Alveolar de-recruitment
Electrical impedance tomography
Mechanical ventilation
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Health and Rehabilitation Sciences Publications
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