Direct tracheobronchial suction for massive post-extubation atelectasis in premature infants

A prospective four-year study was done in a neonatal intensive care unit (NICU) to evaluate a technique, called direct tracheobronchial suction (DTBS), for rapidly removal of obstructive secretions from the tracheobronchial tree in newborn infants with massive post-extubation atelectasis (PEA). Selected cases who met the following criteria were enrolled: 1) developing new massive atelectasis within 48 hours after extubation; 2) no response to vigorous chest physiotherapy(CPT) and continuous deterioration; and 3) no air-bronchogram in the atelectatic lung field. DTBS was carried on at bedside by direct insertion a 6.5 Fr suction catheter into tracheobronchial tree and suctioning. Clinical and laboratory assessments were made in each case prior to and at two hours after DTBS for comparison. A total of 145 (19.7%, 145/736)) PEA occurred in a consecutive 736 postextubated newborn infants. Thirty-one atelectasis (4.2%, 31/736) that developed in 18 infants were managed with DTBS. There was a significant higher incidence of PEA developed, as well as a higher ratio of PEA been treated by DTBS, in the group of body weight < 1,500 g than the group of > or = 1,500 g. All except one infants weighed less than 1,500 g, with a mean of 1,043 +/- 269 g. Sixteen infants had been intubated for more than seven days with a mean of 14.1 +/- 5.0 days. Nine infants required more than one session of DTBS. DTBS was quite effective in immediate removal of retained secretions and improvement of pulmonary condition. By clinical assessment, respiratory distress improved with increased audible air entry on the affected lung, decreased chest retractions, and a significant fall in respiratory rate and heart rate. Arterial blood gases analysis showed significant improvement of pH, partial pressure of carbon dioxide and oxygenation ratio. By chest radiograph, DTBS resulted partial or nearly complete resolution of the atelectasis in all cases. DTBS procedures were well tolerated by all infants without significant sequelae.

This study suggests that DTBS is a simple and effective therapeutic modality to rapidly correct the massive PEA which resist to vigorous CPT in small infants.