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Lung volume and Cardiorespiratory changes during open and closed endotracheal suction in ventilated newborn infants
  1. Adam B Hoellering (abhoellering{at}doctors.org.uk)
  1. Royal Children's Hospital, Australia
    1. Beverley Copnell (bev.copnell{at}rch.org.au)
    1. Royal Children's Hospital, Australia
      1. Peter Anderson Dargaville (peter.dargaville{at}dhhs.tas.gov.au)
      1. Royal Hobart Hospital, Australia
        1. John F Mills (john.mills{at}rch.org.au)
        1. Royal Children's Hospital, Australia
          1. Colin J Morley (colin.morley{at}rwh.org.au)
          1. Royal Women's Hospital, Australia
            1. David G Tingay (david.tingay{at}rch.org.au)
            1. Royal Children's Hospital, Australia

              Abstract

              Objectives: To compare change in lung volume (ΔVL)using respiratory inductive plethysmography (RIP), time to recover pre-suction lung volume (trec) and the cardiorespiratory disturbances associated with open suction (OS) and closed suction (CS) in ventilated infants. Design: Randomised blinded cross-over trial. Setting: Neonatal intensive care unit. Patients: Thirty neonates, 20 receiving SIMV and 10 HFOV (four receiving muscle relaxant). Interventions: OS and CS were performed, in a random order, on each infant using a 6FG catheter at -19kPa for 6s and repeated after one minute. Outcome measures: ΔVL, oxygen saturation (SpO2) and heart rate were continuously recorded from two minutes before until five minutes after suction. Lowest values were identified during 60s after suction. Results: There were variations in all parameters during CS and OS. During SIMV no differences were found between OS and CS for maximum ΔVL or trec; mean (95%CI) difference of 3.5 mL/kg (-2.8, 9.7) and 4s (-5, 13) respectively. During HFOV trec was longer during OS by 13s [0, 27]) but there was no difference in the maximum ΔVL of 0.1 mV [-0.02, 0.22]). A small reduction in SpO2 with CS in the SIMV group mean difference 6% [2.1, 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 ΔVL or trec. During HFOV there was no difference in loss of lung volume but a slightly longer time to recover after OS.

              • endotracheal suction
              • infant, newborn
              • mechanical ventilation
              • neonatal respiratory
              • respiratory inductive plethysmography

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