A Comparison Of The Effectiveness Of Deep And Shallow Endotracheal Suctioning Of The Adult Ventilated Patients

Object: To compare the efficacy and complications of deep (conventional methods: catheter is passed into the endotracheal tube until resistance is met and then retracted 2 cm before suctioning) versus shallow (catheter passed to the tip of the tube, but does not extend beyond the length of the tube more than 2cm) suctioning of the endotracheal tube in ventilated adults, to explore a more safe and effective depth of suction for ventilated patients.Method:A prospective randomized controlled trials was conducted in a 26-bed intensive care unit of the first affiliated hospital of medical collage of shihezi University. From March to October 2008, 38 cases of adult patients with mechanical ventilation for over 48 h were enrolled and randomly allocated to either routine or shallow endotracheal suctioning. Before that, we premeasure the actual length of endotracheal tube of every patient for the scheduled depth of catheter insertion. The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂ ), respiratory rate(RR), tidal volume(VT), peak airway pressure (Ppeak), plateau pressure (Pplat) and mean airway pressure (Pmean), measured on a cardio-respiratory monitor or ventilator screen, was recorded respectively 1min before suction and 1, 3, 5 and 10min following suction , absolute or percentage change were compared between the two groups. Besides, the effect of one suctioning was evaluated by auscultation of the moist rales, the times of sputum suction in 24 hours, and the complication such as mucosal trauma, blockage of the airway, and arrhythmia, et al, were also observed and compared. All of the data were input into and analyzed by the database with the software of SPSS13.0, The difference in the two group was analyzed using repeated measures﹑independent t test and chi-square test, P<0.05 for the statistical difference.Result:①Both of the routine deep endotracheal suctioning group and the minimally invasive airway suctioning group had significant increase of heart rate and blood pressure one min after suction than baseline(P<0.05), furthermore, deep suction resulted in a statistical higher increase in HR and SBP (P<0.05).②The deep groups had significantly increase of Ppeak, Pmean and respiratory rate at one min after suction(P<0.05), and that increase was also significantly higher than shallow group (P<0.05); Ppeak and Pmean in shallow group had a marked decline below the baseline 10 minafter suction(P<0.05). The deep group patients experienced a significantly drop in dynatic compliance following suctioning (P<0.05),while CD and CS of shallow group had no change. (P>0.05). SpO₂ in the shallow group showed no statistical significance change after suction (P>0.05), while that in deep group were significantly higher than baseline at 10min after suction (P<0.05).③Effects of the two depth: Deep group had statistically significant longer intervals, thus a less times of sputum suction in 24 hours, and a higher scores of effectiveness than shallow group (P<0.05). There was no significant difference of the incidence of pulmonary complications including mucosal trauma, blockage of the airway, and arrhythmia between the two groups (P>0.05), but at the same time, a slightly higher incidence in deep group could also be found.Conclusion:This study confirmed that either the routine endotracheal suctioning or the minimally invasive airway suctioning caused a significant but transient increase of heat rate, blood pressure and pressure of airway, and a drop of pulmonary compliance, especially the routine deep suctioning increased or dropped to a greater extent. In spite of this, this study demonstrates that for the patients who had more and thick secretion located in deep airway, and unable to cough a little, shallow suctioning seemed to be inadequate removal of secretions and subsequent tube blockage, while the routine endotracheal suctioning could play a satisfied role and reduce the frequency of suction which can improve the effect of sputum suction and therefore, to some extent, may reduce the risk of pulmonary complications. Concerned this, nurses should be flexible to grasp the depth of suctioning based on the specific situation of the patients. Further high quality research concerned other patients would be required to conclusively establish whether there are any benefits to deep or shallow suctioning. As the suction itself is not a benign process, the most important job during airway caring is certainty to moist well and postural drainage and other Physiotherapy measures , and try to avoid suctioning unnecessary.