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COVID-19 / Coronavirus Outbreak: Protecting the Airway - Endotracheal Intubation
Published on: May 13, 2020
Evaluating the Effects of Post-Intubation Endotracheal Suctioning Before Surgery on Respiratory Parameters in
Mahin Seyedhejazi1, Dariush Sheikhzade1, Behzad Aliakbari Sharabiani1
1Department of Anesthesiology and Critical Care, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Insights
Open endotracheal suctioning (ETS) in children with pulmonary crackles before surgery improved oxygen saturation and reduced complications. However, it did not significantly affect airway pressure or CO2 levels, and may increase heart rate.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Care
- Critical Care Medicine
Background:
- Endotracheal suctioning (ETS) is a standard procedure for secretion clearance in intubated patients.
- Previous studies on open ETS efficacy have yielded controversial results.
- The impact of pre-operative open ETS on pediatric patients with pulmonary crackles requires further investigation.
Purpose of the Study:
- To evaluate the effects of open endotracheal suctioning (ETS) performed before surgery on respiratory parameters in pediatric patients presenting with pulmonary crackles.
- To compare hemodynamic and respiratory outcomes between children who underwent open ETS and those who did not.
- To assess the safety and efficacy of pre-operative open ETS in this specific patient population.
Main Methods:
- A randomized clinical trial involving 100 pediatric patients with pulmonary crackles scheduled for surgery.
- Patients were divided into two groups: Group A (n=50) received deep and open ETS until crackles cleared, while Group B (n=50) received anesthesia without suctioning.
- Hemodynamic and respiratory parameters were monitored and compared between the groups.
Main Results:
- Group A demonstrated significantly higher oxygen saturation during and after surgery (P < 0.001).
- Pulmonary crackles were significantly reduced in Group A post-suctioning and pre-extubation (P < 0.001).
- No significant differences were observed in end-tidal CO2, airway pressure, or respiratory rate; however, Group A had lower complication rates and emergence times (P < 0.001).
Conclusions:
- Open and deep endotracheal suctioning before surgery positively impacts oxygen saturation and reduces complications and anesthesia emergence time in children with pulmonary crackles.
- While effective in clearing secretions and improving oxygenation, ETS did not show benefits for airway pressure, ETCO2, blood pressure, or respiratory rate.
- The observed increase in heart rate in the ETS group warrants attention for potential risks of dysrhythmia and hemodynamic instability.
Background:
Endotracheal suctioning (ETS) is a common procedure in intubated patients for the clearance of secretions and improvement of oxygenation.
Objectives:
Owing to the controversies in previous studies, we studied the effects of open ETS before surgery on respiratory parameters in children with pulmonary crackles.
Methods:
In this clinical trial, 100 children with pulmonary crackles, candidates for surgery were randomly assigned into two groups. After intubation, in the group A (n = 50), deep and open suction was done until the crackle was cleared and in the group B (n = 50), anesthesia without suctioning was continued. Hemodynamic and respiratory parameters were compared.
Results:
The patients in group A had higher oxygen saturation with a statistically significant difference in 15th to 75th minutes of the operation (P < 0.001) and in post-anesthetic care unit (P = 0.004). After suction, before and after extubation, there was a statistically significant reduction of crackles in the group A in comparison to the group B (P < 0.001). There was no statistically significant difference in the end-tidal CO2, airway pressure and respiratory rate between the two groups (P > 0.05). Relevant complications and the emergence of anesthesia time were statistically lower in the group A (P < 0.001). There was no statistically significant change in terms of blood pressure in the two groups (P > 0.05). The heart rate in the 15th, 30th, and 45th minutes of surgery was statistically lower in the group B (P < 0.05).
Conclusions:
This study indicates positive effects of open and deep suction in improving oxygen saturation and reducing complications and emergence time. Pulmonary auscultation of the group A before and after weaning was statistically better than group B. However, this study found no positive effect of ETS on airway pressure, ETCO2, blood pressure, and respiratory rate. Meanwhile, increased heart rate in the group A might introduce the potential risk of dysrhythmia and hemodynamic instability.
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