Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation
Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation
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DOI：
10.1007/s001340100897
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发表时间：
2001-04-01
影响因子：
38.9
通讯作者：
Pesenti, A
中科院分区：
文献类型：
--
作者：
Cereda, M;Villa, F;Pesenti, A
目的：封闭式吸引系统（CS）在气管吸引期间保持与机械呼吸机的连接，并声称可限制肺容量和氧合的损失。我们比较了CS和开放式吸引系统（OS）进行气管内吸痰期间肺容量、氧合、气道压力和血流动力学的变化。设计：前瞻性随机研究。设置：大学医院的重症监护室。患者：我们招募了10名患者，使用Siemens Servo 900呼吸机进行容量控制（VC）通气（PaO 2/FIO 2 192 +/- 70）。PEEP 10.7 +/- 3.9 cmH（2）O）。干预：我们进行了四次连续的气管抽吸操作，两次为CS，两次为OS，间隔20分钟。在抽吸操作期间持续抽吸20 s。测量和主要结果：我们通过呼吸感应体积描记术测量呼气末肺容积变化（DeltaV（L））、潮气量（V-Trt）、呼吸频率（RR）和分钟通气量（V-Ert）;动脉血氧饱和度（SpO（2））、气道压力和动脉压（PA）。OS期间的肺容量损失（Δ V（L）1.2 +/- 0.71）显著高于CS期间（Δ V（L）0.14 +/- 0.1 I）。在OS期间，我们观察到SpO（2）显著下降，而在CS期间，变化仅为轻微。在CS期间，未中断通气，我们观察到RR立即增加（由于呼吸机触发器的激活），而V-Trt降低，V-Ert维持。避免吸痰相关的肺容量损失对肺泡萎陷倾向增加的患者有帮助，CS允许拍卖，同时避免肺容量的急剧下降，并且在我们使用的VC通气设置期间似乎是安全的。
Objective: A closed suction system (CS) maintains connection with the mechanical ventilator during tracheal suctioning and is claimed to limit loss in lung volume and oxygenation. We compared changes in lung volume, oxygenation, airway pressure and hemodynamics during endotracheal suctioning performed with CS and with an open suction system (OS).Design: Prospective, randomized study.Setting: Intensive care unit in a university hospital.Patients: We enrolled ten patients, volume-controlled (VC) ventilated with a Siemens Servo 900 ventilator (PaO2/FIO2 192 +/- 70. PEEP 10.7 +/- 3.9 cmH(2)O).Interventions: We performed four consecutive tracheal suction maneuvers, two with CS and two with OS, at 20-min intervals. During the suction maneuvers continuous suction was applied for 20 s.Measurements and main results: We measured end-expiratory lung volume changes (DeltaV(L)) tidal volume (V-Trt), respiratory rate (RR) and minute volume (V-Ert) by respiratory inductive plethysmography; arterial oxygen saturation (SpO(2)), airway pressure and arterial pressure (PA). Loss in lung volume during OS (DeltaV(L) 1.2 +/- 0.71) was significantly higher than during CS (DeltaV(L) 0.14 +/- 0.1 I). During OS we observed a marked drop in SpO(2), while during CS the change was only minor. During CS ventilation was not interrupted and we observed an immediate increase in RR (due to the activation of the ventilator's trigger), while V-Trt decreased, V-Ert was maintained.Conclusions: Avoiding suction-related lung volume loss can be helpful in patients with an increased tendency to alveolar collapse, CS allows auctioning while avoiding dramatic drops in lung volumes and seems to be safe during the VC ventilation setting that we used.