Effectiveness and side effects of closed and open suctioning: an experimental evaluation.
OBJECTIVE
To compare the effectiveness of closed system suctioning (CSS) and open system suctioning (OSS) and the side effects on gas exchange and haemodynamics, during pressure-controlled ventilation (PCV) or continuous positive airway pressure (CPAP).


METHODS
Bench test and porcine lung injury model.


METHODS
Twelve bronchoalveolar saline-lavaged pigs.


METHODS
Research laboratory in a university hospital.


METHODS
In a mechanical lung, the efficacy of OSS and CSS with 12 and 14 Fr catheters were compared during volume-control ventilation, PCV, CPAP 0 or 10 cmH(2)O by weighing the suction system before and after aspirating gel in a transparent trachea. Side effects were evaluated in the animals with the same ventilator settings during suctioning of 5, 10 or 20 s duration.


RESULTS
Suctioning with 12 and 14 Fr catheters was significantly more efficient with OSS (1.9+/-0.1, 2.8+/-0.9 g) and with CSS during CPAP 0 cmH(2)O (1.8+/-0.2, 4.2+/-0.5 g) as compared to CSS during PCV (0.2+/-0.2, 0.8+/-0.3 g) or CPAP 10 cmH(2)O (0.0+/-0.1, 0.7+/-0.4 g), p<0.01 (means +/- SD). OSS and CSS at CPAP 0 cmH(2)O resulted in a marked decrease in SpO(2), mixed venous oxygen saturation and tracheal pressure, p<0.001, but the side effects were considerably fewer during CSS with PCV and CPAP 10 cmH(2)O, p<0.05.


CONCLUSIONS
Irrespective of catheter size, OSS and CSS during CPAP 0 cmH(2)O were markedly more effective than CSS during PCV and CPAP 10 cmH(2)O but had worse side effects. However, the side effects lasted less than 5 min in this animal model. Suctioning should be performed effectively when absolutely indicated and the side effects handled adequately.
Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden. sophie.lindgren@vgregion.se
Sophie
S
Lindgren
Birgitta
B
Almgren
Marieann
M
Högman
Sven
S
Lethvall
Erik
E
Houltz
Stefan
S
Lundin
Ola
O
Stenqvist
D000704:Analysis of Variance; D000818:Animals; D006439:Hemodynamics; D055370:Lung Injury; D011175:Positive-Pressure Respiration; D011312:Pressure; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial; D013396:Suction / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013552:Swine