title: Endotracheal suctioning causes right upper lobe collapse in intubated children.
abstract: OBJECTIVE
  Right upper lobe collapse is a common radiographic finding in intubated children. We hypothesized that deep suctioning and uncontrolled negative pressures during endotracheal tube suctioning were significant contributory factors.
  
  
  METHODS
  The incidence of right upper lobe (RUL) collapse in intubated, ventilated children on a paediatric cardiac intensive care unit was determined over a 3-month period (n = 102). Graduated suction catheters and suction vacuums of < 165 cm H2O were then introduced. Another prospective audit was carried out 3 months later (n = 60).
  
  
  RESULTS
  We found that 24% developed RUL collapse and 4 developed an apical pneumothorax. Following the introduction of graduated catheters and controlled vacuums pressures; a significant reduction in the incidence of RUL collapse, to 7%, was observed (p < 0.05).
  
  
  CONCLUSIONS
  We conclude that high negative pressure and deep-suctioning causes RUL collapse in children. Any lobar collapse not only prolongs the child's stay in intensive care, but can be associated with further morbidity which may have a serious implication. By improving suctioning technique this morbidity can be significantly reduced.
authors.affiliation: Department of Radiology, Royal Liverpool Children's NHS Trust, UK.
authors.forename: A E
authors.initials: AE
authors.lastname: Boothroyd
authors.forename: B V
authors.initials: BV
authors.lastname: Murthy
authors.forename: A
authors.initials: A
authors.lastname: Darbyshire
authors.forename: A J
authors.initials: AJ
authors.lastname: Petros
mesh_terms: D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000209:etiology*; D013396:Suction / Q000009:adverse effects*