Shallow versus deep endotracheal suctioning in young rabbits: pathologic effects on the tracheobronchial wall

The traditional technique for endotracheal suctioning of intubated neonates consists of inserting a catheter until resistance is met, withdrawing slightly, and applying suction. The extent of tissue damage caused by the traditional (deep) technique v that caused by an alternative shallow technique was studied with an animal model. Six 3-week-old rabbits were anesthetized, intubated, and suctioned every 15 minutes for six hours by neonatal intensive care unit nurses who were unaware of the study purpose. Three rabbits were suctioned by means of the deep technique, whereas the other three received shallow suctioning achieved by inserting the catheter no further than a premeasured distance. Light microscopy showed significantly increased necrosis and inflammation following deep suctioning. Electron microscopy revealed greater loss of cilia and increased mucus with the deep technique. To confirm our initial assumption that the deep technique is still used extensively by neonatal intensive care units throughout the country, a mail survey was conducted. Of the 405 (43%) neonatal intensive care unit physicians who responded, 82% reported frequent or exclusive use of the deep technique for routine suctioning. In this study, the fact that deep suctioning results in significantly more tracheobronchial pathology than does a shallow, premeasured technique is shown. It is recommended that nurseries change their current practice and adopt the shallow technique for routine suctioning of intubated neonates.