title: Prevention of endotracheal suctioning-induced alveolar derecruitment in acute lung injury.
abstract: We studied endotracheal suctioning-induced alveolar derecruitment and its prevention in nine patients with acute lung injury. Changes in end-expiratory lung volume measured by inductive plethysmography, positive end-expiratory pressure-induced alveolar recruitment assessed by pressure-volume curves, oxygen saturation, and respiratory mechanics were recorded. Suctioning was performed after disconnection from the ventilator, through the swivel adapter of the catheter mount, with a closed system, and with the two latter techniques while performing recruitment maneuvers during suctioning (40 cm H2O pressure-supported breaths). End-expiratory lung volume after disconnection fell more than with all other techniques (-1,466 +/- 586, -733 +/- 406, -531 +/- 228, -168 +/- 176, and -284 +/- 317 ml after disconnection, through the swivel adapter, with the closed system, and with the two latter techniques with pressure-supported breaths, respectively, p < 0.001), and was not fully recovered 1 minute after suctioning. Recruitment decreased after disconnection and using the swivel adapter (-104 +/- 31 and -63 +/- 25 ml, respectively), was unchanged with the closed system (-1 +/- 10 ml), and increased when performing recruitment maneuvers during suctioning (71 +/- 37 and 60 +/- 30 ml) (p < 0.001). Changes in alveolar recruitment correlated with changes in lung volume (rho = 0.88, p < 0.001) and compliance (rho = 0.9, p < 0.001). Oxygenation paralleled lung volume changes. Suctioning-induced lung derecruitment in acute lung injury can be prevented by performing recruitment maneuvers during suctioning and minimized by avoiding disconnection.
authors.affiliation: Department of Anesthesiology and Intensive Care, Agostino Gemelli Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Salvatore M
authors.initials: SM
authors.lastname: Maggiore
authors.forename: Francois
authors.initials: F
authors.lastname: Lellouche
authors.forename: Jerome
authors.initials: J
authors.lastname: Pigeot
authors.forename: Solenne
authors.initials: S
authors.lastname: Taille
authors.forename: Nicolas
authors.initials: N
authors.lastname: Deye
authors.forename: Xavier
authors.initials: X
authors.lastname: Durrmeyer
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Richard
authors.forename: Jordi
authors.initials: J
authors.lastname: Mancebo
authors.forename: Francois
authors.initials: F
authors.lastname: Lemaire
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000403:Airway Resistance; D001784:Blood Gas Analysis; D006801:Humans; D007442:Intubation, Intratracheal; D008170:Lung Compliance; D008176:Lung Volume Measurements; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010991:Plethysmography; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods; D011650:Pulmonary Alveoli / Q000293:injuries*; D012044:Regression Analysis; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015656:Respiratory Mechanics; D013396:Suction / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D016019:Survival Analysis; D013990:Tidal Volume