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Effects of Endotracheal Suctioning With Expiratory Pause in Infants

Ana Paula Dattein Peiter1,2, Taila Cristina Piva3, Taciana Fassbinder Piccoli3

  • 1Ms. Dattein Peiter is affilaited with Department of Physical Therapy, Hospital da Criança Conceição, Porto Alegre, Brazil.

Respiratory Care
|May 2, 2026
PubMed

Insights

Closed-system suctioning with an expiratory pause effectively removed more secretions in infants. However, this technique also increased driving pressure and inspiratory resistance, requiring careful consideration during pediatric intensive care unit procedures.

Area of Science:

  • Pediatric Intensive Care
  • Respiratory Physiology
  • Critical Care Medicine

Background:

  • Endotracheal suctioning is a standard procedure in pediatric ICUs.
  • Closed-system suctioning offers ventilatory benefits but may be less effective for secretion removal.
  • An expiratory pause technique is an alternative for closed-system suctioning.

Purpose of the Study:

  • To compare the effectiveness of closed-system endotracheal suctioning with an expiratory pause versus conventional closed suctioning.
  • To evaluate the volume of suctioned secretions, respiratory mechanics, and hemodynamic parameters.
  • To assess the impact of the expiratory pause technique on infant ventilation.

Main Methods:

  • A randomized crossover pilot trial involving infants on invasive mechanical ventilation.
  • Infants underwent both conventional closed suctioning and closed suctioning with an expiratory pause, with a 2-hour interval between techniques.
  • Evaluated parameters included secretion volume, respiratory mechanics (compliance, resistance, driving pressure), and hemodynamic variables.

Main Results:

  • The expiratory pause technique yielded significantly more suctioned secretions (1.4g vs 1.1g).
  • An increase in driving pressure and inspiratory resistance was observed after suctioning with an expiratory pause.
  • No significant differences were found in hemodynamic parameters between the two techniques.

Conclusions:

  • Closed-system suctioning with an expiratory pause is more effective for removing secretions in infants.
  • The technique leads to increased driving pressure and inspiratory resistance, necessitating careful monitoring.
  • This method offers potential benefits for secretion clearance in mechanically ventilated infants.
Abstract

Keywords:
endotracheal suctioninginvasive mechanical ventilationpediatric intensive care unitsrespiratory therapy

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