Prevention of Endotracheal Suctioning-Related Complications: a Comparison between Manual and Ventilator Hyperinflation/Hyperoxygenation Salem Amina Hemida Lecturer of Critical Care and Emergency Nursing, Department of Critical Care & Emergency Nursing, Faculty of Nursing, University of Alexandria, Egypt Online published on 19 January, 2015. Abstract Patients dependent on mechanical ventilation often need to have mucus suctioned from their airways. Endotracheal suction (ETS) is a procedure which aims to keep airways patent by mechanically removing accumulated pulmonary secretions in critically ill patients with artificial airways. Despite being a necessary procedure, it can lead to serious complications(1–2). The most common complication associated with the endotracheal suctioning procedure is hypoxemia leading to hemodynamic alterations. Hypoxemia is resulting from either disconnection from the ventilator or the removal of respiratory gases with application of negative pressure.(3–5) Consequently, the majority of ETS researches have focused on techniques to minimize suction - induced hypoxemia and hemodynamic alterations. Hyperinflation/Hyperoxygenation is a technique used by a nurse and/or physiotherapist to mimic a cough so that airway secretions are mobilized toward the larger airways, where they can easily be removed; reinflate areas of pulmonary collapse and improve oxygenation. Hyperinflation/Hyperoxygenation may be delivered by the ventilator or manually by manual resuscitation bag (MRB)(6). But, it is uncertain which method is better; should we use the ventilator or the manual resuscitation bag to hyperinflate/hyperoxygenate the patient before, during and after the suctioning procedure. Aim This study was aimed to compare between the effects of manual hyperinflation/hyperoxygenation (MHI) and ventilator hyperinflation (VHI) on blood gas and hemodynamic parameters. Method A prospective, randomized crossover study of thirty patients, who were intubated, ventilated and hemodyamically stable and met the inclusion criteria was used. Suctioning was performed only when the researcher identified a clinical need for ETS. Hyperinflation/hyperoxygenation technique (manual or ventilator) was determined randomly. The other technique was used at least 2 hours after the first intervention when the patient again required suctioning. Hemodynamic parameters and blood gases were obtained before the procedure (baseline) and 30 seconds, 60 seconds and 120 seconds after suctioning. The variables of hemodynamic and ABG variables were analyzed by use of an analysis of variance (ANOVA) for repeated measures. Statistical significance was set at p < 0.05. Results There was no significant difference in hemodynamic and ABG variables between either techniques of treatment. Conclusion Although both methods produced non-statistically significant differences in relation to hemodynamic and ABGs parameters, MRB produced higher changes in Mean Arterial Pressure (MAP) Heart Rate (HR) Respiratory Rate (RR) Diastolic Blood Pressure (DBP), which may have a deleterious effects on critically ill patients. Moreover, MV produced higher improvement in Arterial Blood Gases (ABGs) than MRB. Therefore, mechanical ventilator is superior to MRB in delivering hyperinflation/hyperoxygenation. Top Keywords Nursing Care, Critically Ill Patients, Endotracheal Suctioning, Manual Hyperinflation, Ventilator Hyperventilation, Arterial Blood Gases, Hemodynamic Parameters. Top |