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Improved bronchial cleansing in intensive care patients with a new double-lumen catheter
C Schmidt1, R Düsing, A Savramis
1Medizinische Poliklinik, Rheinisch-Westflischen, Wilhelms-Universität, Bonn, Germany.
Objectives:
A new double lumen catheter with a small channel for application of rinsing solution in deeper parts of the endobronchial tree was developed and its efficiency was tested in two trials.
Design:
Comparison of the new catheter in 2 controlled studies with the traditional way of suctioning and with conventional endotracheal lavage in a randomized block design.
Setting:
Intensive care unit of a university hospital.
Patients:
In the first study, endobronchial cleansing with the new catheter was compared to the traditional way of suctioning in 12 long-time ventilated patients. In the second study, 28 ventilated patients received either conventional lavage or lavage with the new catheter.
Interventions:
In the first trial the bronchial system of each patient was suctioned 25 times with a conventional technique or cleansed by using the new catheter. In the second study, patients alternatively received conventional lavage 88 times or lavage 88 times with the new catheter.
Measurements And Results:
Drained secretions averaged 0.84 +/- 0.28 ml using conventional cleaning as compared to 11.02 +/- 0.84 ml with the new catheter. This was accompanied by a significant (p < 0.001) increase in PaO2 of 24.20 +/- 7.90 mmHg after 10 min compared to nearly unchanged PaO2 after normal suctioning. In the second study, suctioned volume was 2.48 +/- 0.21 ml using conventional endotracheal lavage and 10.55 +/- 0.47 ml using the new catheter. Use of the double-lumen catheter induced a significant increase in PaO2 by 30.90 +/- 3.90 mmHg within 10 min. The changes in PaO2 correlated with the drained volume.
Conclusion:
Both studies show that suctioning with the new double lumen catheter allows drainage of a larger volume of secretions and results in a greater improvement of oxygenation.