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Endotracheal suctioning causes right upper lobe collapse in intubated children

A E Boothroyd1, B V Murthy, A Darbyshire

  • 1Department of Radiology, Royal Liverpool Children's NHS Trust, UK.

Acta Paediatrica (Oslo, Norway : 1992)
|December 1, 1996
PubMed

Insights

Deep endotracheal tube suctioning can cause right upper lobe collapse in children. Modifying suction technique significantly reduced this complication, improving patient outcomes in intensive care.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Medical Device Technology

Background:

  • Right upper lobe (RUL) collapse is a frequent radiographic observation in pediatric patients requiring mechanical ventilation.
  • Endotracheal tube (ETT) suctioning, particularly with deep insertion and uncontrolled negative pressures, is suspected as a major contributor to RUL collapse.

Purpose of the Study:

  • To investigate the association between ETT suctioning parameters and the incidence of RUL collapse in intubated children.
  • To evaluate the effectiveness of modified suctioning techniques in reducing RUL collapse.

Main Methods:

  • A prospective audit was conducted in a pediatric cardiac intensive care unit to determine the baseline incidence of RUL collapse (n=102).
  • Following the baseline audit, graduated suction catheters and controlled negative suction pressures (< 165 cm H2O) were implemented.
  • A second prospective audit was performed to assess the impact of the intervention (n=60).

Main Results:

  • The initial incidence of RUL collapse was 24%, with 4 cases of apical pneumothorax.
  • After implementing graduated catheters and controlled suction pressures, the incidence of RUL collapse significantly decreased to 7% (p < 0.05).

Conclusions:

  • High negative pressures and deep suctioning during ETT care are causative factors for RUL collapse in pediatric patients.
  • Implementing improved suctioning techniques, including controlled pressures and graduated catheters, can significantly reduce the incidence of RUL collapse.
  • Reducing lobar collapse minimizes prolonged intensive care unit stays and associated morbidities in critically ill children.
Abstract

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