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Erschienen in:
01.08.2004 | Original
Effectiveness and side effects of closed and open suctioning: an experimental evaluation
Erschienen in: Intensive Care Medicine | Ausgabe 8/2004
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Objective
To compare the effectiveness of closed system suctioning (CSS) and open system suctioning (OSS) and the side effects on gas exchange and haemodynamics, during pressure-controlled ventilation (PCV) or continuous positive airway pressure (CPAP).
Design
Bench test and porcine lung injury model.
Participants
Twelve bronchoalveolar saline-lavaged pigs.
Setting
Research laboratory in a university hospital.
Interventions
In a mechanical lung, the efficacy of OSS and CSS with 12 and 14 Fr catheters were compared during volume-control ventilation, PCV, CPAP 0 or 10 cmH2O by weighing the suction system before and after aspirating gel in a transparent trachea. Side effects were evaluated in the animals with the same ventilator settings during suctioning of 5, 10 or 20 s duration.
Measurements and results
Suctioning with 12 and 14 Fr catheters was significantly more efficient with OSS (1.9±0.1, 2.8±0.9 g) and with CSS during CPAP 0 cmH2O (1.8±0.2, 4.2±0.5 g) as compared to CSS during PCV (0.2±0.2, 0.8±0.3 g) or CPAP 10 cmH2O (0.0±0.1, 0.7±0.4 g), p<0.01 (means ± SD). OSS and CSS at CPAP 0 cmH2O resulted in a marked decrease in SpO2, mixed venous oxygen saturation and tracheal pressure, p<0.001, but the side effects were considerably fewer during CSS with PCV and CPAP 10 cmH2O, p<0.05.
Conclusions
Irrespective of catheter size, OSS and CSS during CPAP 0 cmH2O were markedly more effective than CSS during PCV and CPAP 10 cmH2O but had worse side effects. However, the side effects lasted less than 5 min in this animal model. Suctioning should be performed effectively when absolutely indicated and the side effects handled adequately.