ORIGINAL ARTICLES

Lung volume and cardiorespiratory changes during open and closed endotracheal suction in ventilated newborn infants

A B Hoellering¹, B Copnell^1,2, P A Dargaville³, J F Mills¹, C J Morley^1,2, D G Tingay^1,2,4

¹ Department of Neonatology, Royal Children’s Hospital, Melbourne, Victoria, Australia
² Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
³ Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
⁴ Department of Paediatrics, University of Melbourne, Victoria, Australia

Dr A B Hoellering, Department of Neonatology, Royal Children’s Hospital, Flemington Road, Parkville, 3052 Victoria, Australia; abhoellering{at}doctors.org.uk

Objectives: To compare change in lung volume (V_L), using respiratory inductive plethysmography, time to recover pre-suction lung volume (t_rec) and the cardiorespiratory disturbances associated with open suction (OS) and closed suction (CS) in ventilated infants.

Design: Randomised blinded crossover trial.

Setting: Neonatal intensive care unit.

Patients: Thirty neonates, 20 receiving synchronised intermittent mandatory ventilation (SIMV) and 10 high-frequency oscillatory ventilation (HFOV, four receiving muscle relaxant).

Interventions: OS and CS were performed, in random order, on each infant using a 6FG catheter at –19 kPa for 6 seconds and repeated after 1 minute.

Outcome measures: V_L, oxygen saturation (SpO₂) and heart rate were continuously recorded from 2 minutes before until 5 minutes after suction. Lowest values were identified during the 60 seconds after suction.

Results: Variations in all measures were seen during CS and OS. During SIMV no differences were found between OS and CS for maximum V_L or t_rec; mean (95% CI) difference of 3.5 ml/kg (–2.8 to 9.7) and 4 seconds (–5 to 13), respectively. During HFOV t_rec was longer during OS by 13 seconds (0 to 27) but there was no difference in the maximum V_L of 0.1 mV (–0.02 to 0.22). A small reduction in SpO₂ with CS in the SIMV group mean difference 6% (2.1 to 9.8) was the only significant difference in physiological measurements.

Conclusions: Both OS and CS produced transient variable reductions in heart rate and SpO₂. During SIMV there was no difference between OS and CS in V_L or t_rec. During HFOV there was no difference in V_L but a slightly longer t_rec after OS.

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CLINICAL AND HORMONAL STRESS RESPONSE FOLLOWING ENDOTRACHEAL SUCTIONING IN VENTILATED NEONATES: A CL

Karel Allegaert, et al.

Fetal Neonatal Ed. Online, 9 Sep 2008 [Full text]