Effect of endotracheal suctioning on arterial blood gases in children.
The occurrence of hypoxia during endotracheal tube suctioning and its prevention was examined in 25 hemodynamically stable and non-cyanosed pediatric patients. In each patient 4 suction and treatment protocols were studied: 1. pre- and post-suction arterial blood gases (ABG) with no treatment (control). 2. ABG with pre-suction oxygenation. 3. ABG with presuction hyperinflation. 4. ABG with postsuction hyperinflation. With no presuction treatment the PO2 and saturation fell significantly after suctioning from control level of 116.6 +/- 9.4 mmHg to 93 +/- 9.3 mmHg post-suction and 97.2 +/- 0.4% to 92.8 +/- 1.4% (p less than 0.001) respectively. In 6 patients with low but adequate pre-suction PO2, hypoxic levels (PO2 less than 60 mmHg) were found post-suction. The significant fall in PO2 was completely prevented by pre-suction oxygenation. Post-suction hyperinflation induced a rapid return of the PO2 to control levels. These results suggest that severe hypoxia might occur during endotracheal suctioning and can be prevented by pre-oxygenation. We recommend 1 min oxygenation with FiO2 1.0 prior to suctioning procedures and intermittent hyperinflation with 100% oxygen during repeated endotracheal suction passes to prevent hypoxia, especially in children in respiratory failure who already have low or borderline pre-suction PO2.
Kerem
E
E
Department of Pediatrics, Hadassah University Hospital, Jerusalem, Israel.
Yatsiv
I
I
Goitein
K J
KJ
D001784:Blood Gas Analysis; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000097:blood* / Q000209:etiology / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D007327:Insufflation; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal; D008297:Male; D010102:Oxygen Inhalation Therapy; D011446:Prospective Studies; D012121:Respiration, Artificial; D013396:Suction / Q000009:adverse effects*