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Warning! Suctioning. A lung model evaluation of closed suctioning systems
O Stenqvist1, S Lindgren, S Kárason
1Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Göteborg, Sweden. ola.stenqvist@aniv.gu.se
Acta Anaesthesiologica Scandinavica
|February 13, 2001
Summary
Closed system suctioning (CSS) risks high intrinsic positive end-expiratory pressure (PEEP) and extreme negative pressures during ventilation. Pressure control ventilation and continuous positive airway pressure (CPAP) modes are safer alternatives for mechanical ventilation.
Area of Science:
- Mechanical Ventilation
- Respiratory Care
- Pulmonary Physiology
Background:
- Closed system suctioning (CSS) is used to prevent alveolar collapse.
- Ventilator manufacturers warn of extreme negative pressures with CSS, potentially impairing ventilator function.
Purpose of the Study:
- To evaluate the impact of closed system suctioning (CSS) on ventilator performance.
- To compare CSS effects across different ventilation modes and parameters.
Main Methods:
- Suctioning via 12 or 14 Fr catheter at -50 kPa vacuum using open or CSS techniques.
- Lung model ventilated with Servo 900C/300, varying I:E ratios and PEEP.
- Measurement of respiratory volumes and alveolar pressure.
Main Results:
- CSS with a 14 Fr catheter caused significant PEEP increase (11 to 23 cm H2O) and alveolar pressure drops (-10 cm H2O below set PEEP).
- Lower tidal volumes, inverse I:E ratios, and secretions exacerbated negative pressures (down to -92 cm H2O).
- CSS had fewer effects during pressure control ventilation compared to volume control.
Conclusions:
- CSS is not recommended for volume control ventilation due to risks of intrinsic PEEP and extreme negative pressures.
- Pressure control ventilation demonstrates reduced intrinsic PEEP effects.
- Continuous positive airway pressure (CPAP) mode minimizes intrinsic PEEP during catheter insertion and sub-atmospheric pressure during suctioning.