[Does directed bronchoscopic bronchial cleansing have an advantage over conventional suctioning? A prospective study of hemodynamics, gas exchange and suction-induced mucosal lesions in long-term ventilated patients].
Hypoxic complications and epithelial damage to the trachea and bronchi during conventional blind suctioning have been described in the literature. Fiberoptic suctioning and examination of the trachea of each long-term ventilator patient as a routine method has been recommended in recent studies. We investigated the effect of a conventional tracheal suction technique compared to precise fiberbronchoscopic suction on cardiocirculatory function and gas exchange in mechanically ventilated patients. METHOD. In 40 long-term ventilator patients tracheobronchial toilet was performed either conventionally (group I; n = 20; 15 s of endotracheal suction with no mechanical ventilation during suctioning) or bronchoscopically (group II; n = 20; bronchoscope Olympus 1 T 10; mechanical ventilation during suctioning). Measurements were performed before, immediately after, and 1, 2, 5, and 15 min after suctioning. FIO2 was not changed before or after suctioning. In 12 long-term ventilator patients (greater than or equal to 8 days) we looked for tracheal mucosal lesions produced by conventional suctioning. RESULTS. There was no effect on cardiocirculatory function in either group (Figs. 1 and 2), but we found a decrease in arterial PO2 after suctioning in all patients (group I from 99 +/- 25 to 81 +/- 19 mmHg, group II from 104 +/- 23 to 80 +/- 17 mmHg [Fig. 3]). The time needed to re-establish the initial PaO2 after suctioning was significantly different in both groups. Whereas the PaO2 returned to the initial value within 2 min after conventional suctioning, we found a decrease in PaO2 in the bronchoscopic group even after 15 min.(ABSTRACT TRUNCATED AT 250 WORDS)
Universitätsklinik für Anaesthesiologie, Klinikum der Universität Ulm/Donau.
F
F
Konrad
H
H
Wiedeck
A
A
Deller
J
J
Diatzko
J E
JE
Schmitz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001980:Bronchi / Q000293:injuries; D001999:Bronchoscopy; D005260:Female; D005336:Fiber Optic Technology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000379:methods*; D013396:Suction / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors
Bringt eine gezielte bronchoskopische Bronchialtoilette gegenüber dem herkömmlichen Absaugen Vorteile? Eine prospektive Untersuchung auf Hämodynamik, Gasaustausch und absaugbedingte Schleimhautläsionen beim langzeitbeatmeten Patienten.