The Comparison Of The Effect On Two Depth Of Endotracheal Suctioning In Orotracheal Intubation With Mechanical Ventilation

Objective:Mechanical ventilation is an important measure to treat respiratory failure,suction is necessary for mechanical ventilation in patients with care operations,and a variety of complications can be reduced due to the treatment of ventilator.During clinical care, the way the nurses operating the suction, the depth of thesuction, the choice of negative pressure, and the appropriate airwayhumidification will directly affect the indicators of circulation parameters andrespiratory mechanics parameters of patients. When clinical nurses aresuctioning for mechanically ventilated patients, they insert the suction tubemerely by feelings and memories, whether the suctioning is too deep or failedto meet the depth of effective suction will lead to the damage of the airway ofthe patients. The subject is trying to research on the regulation of the suctiondepth, searching for the best depth of intubation in mechanically ventilatedpatients, in this way, not only the misuse of intubation injury can be reduced,but also can help nurses regulate mechanical ventilation care operationprocesses, at the same time, it can be reduced in patients with otherphysiological changes and help to prevent complications.Methods:Chose55mechanical ventilated patients with orotracheal intubation fromthe Second Hospital of Jilin University between August2010to October2011as research object, according to the APACHEⅡ score system to assess theseverity of disease, the eligible patients required APACHEⅡ>10,24h≤duration of mechanical ventilation≤72h, the ventilation mode was synchronize-d intermittent mandatory ventilation（SIMV）. Divide the selected patients intoexperimental group （28cases） and control group （27cases） in accordance with the random number table method.The control group received shallowsuctioning （the disposable suction catheter reached the depth of more than thehead end of the endotracheal intubation1cm,the depth approximately is29-33cm）.The experimental group was given the deep suctioning （lifted thedisposable suction catheter1cm when it met with resistance,the depthapproximately is37-39cm）, Recorded the changes in indicators about0min（baseline levels） of the patients before suctioning,2min,5min,10min after thesuction, including heart rate, systolic and diastolic blood pressure, bloodoxygen saturation, peak airway pressure, airway pressure, airway resistance,lung compliance and tidal volume. At the same time, record the changes of thesputum tone before and after the suction, the suctioning number of times a day,the suction interval and adverse reaction. Analyzed and processed the datastatistically by using SPSS17.0, to indicate count data by the chi-square testand measurement data by mean±standard deviation（X±S）, the results would beexplained by two independent samples t-test, analyzed the variance of repeatedmeasurement data, P<0.05would show the difference had statisticalsignificance.Results:1.Comparison of suction effect between two groups: the changes of thesputum tone before and after the suction of two groups of patients did not havea significant difference （P>0.05）, there were significant differences with regardto suctioning number of times a day and suction volume （P<0.05）. Theexperimental group had a less number of suction, longer suction interval, andmore sputum volume.2.Comparison of the effect on cycle parameters in patients with two depthof suction:2minutes after suctioning the systolic blood pressure, diastolic bloodpressure and heart rate of the two groups of patients were significantlyhigher（P<0.05） compared with baseline level（0min）, and the growth of the experimental group is higher than the control group.5minutes after suctioningthe diastolic blood pressure and heart rate of the two groups of patients weresignificantly lower compared with baseline level（0min）.10minutes aftersuctioning the diastolic blood pressure of the two groups of patients lower thanbaseline level（0min） all the same,but the systolic blood pressure and heart rateof the two groups of patients had a certain degree of decline; however,compared with baseline level the difference had no statistical significance.3.Comparison of the effect on respiratory parameters in patients with twodepth of suction: the Ppeak、Pplat had statistically significance compared withbaseline level（P<0.05）2min after suctioning.5minutes after suctioning thePpeak、the airway resistance and lung compliance of the two groups of patientshad statistical significance compared with baseline level（P<0.05）.10minutesafter suctioning the Pplat, the airway resistance, Vt, lung compliance of the twogroups of patients had statistical significance compared with baselinelevel（P<0.05）. there was an decrease in airway resistance, and an increase in Vtand lung compliance of the experimental group.4.The effect on SpO₂in patients with two depth of suction: there was astatistical significance on SpO₂（P<0.05） compared with baseline level,2min,5min,10min after suctioning. And10min after suctioning the data of SpO₂ofthe experimental group was higher than that of the control group.5.The comparison of the adverse reactions and return suction rate with twogroups of patients had no statistical significance （t=0.47,P=0.49,P>0.05）.Because the suction is not completely,the adverse event rate of control group is9.25%.Conclusions：1.Although deep suction has a larger effect on mechanical ventilationorotracheal intubation patients with their heart rates and blood pressures, it canhelp with a longer time interval, less time of suctioning, to reduce the contact of the suction tube and trachea, to lower airway damage caused by the operation,and to try to maintain the original function of the airway.2.Deep suction has reduced the residence time of deep secretions in theairway, which enable the respiratory tract to receive adequate drainage, help toreduce airway resistance, to increase lung compliance, to increase tidal volume,to clear secretions more thoroughly, to maintain a longer time of SpO₂, whichfollows the growth of the time of the permeability. Especially in the early timeof mechanical ventilation, deep suctioning should be implemented at the timewhen patients secreted more sputum.3.Appropriate psychological care should be given to conscious patientsduring suction, which can help them to get rid of the aversion, to coordinatewith the nurses to complete the operation, which will further ensure the comfortof the patients.