Suctioning through a double-lumen endotracheal tube helps to prevent alveolar collapse and to preserve ventilation.
OBJECTIVE
Endotracheal suctioning can cause alveolar collapse and impede ventilation. One reason is the gas flow through a single-lumen endotracheal tube (ETT) provoking a gradient between airway opening and tracheal (P(tr)) pressures. Separately extending the patient tubing limbs of a suitable ventilator into the trachea via a double-lumen ETT should maintain P(tr). Can this technique reduce the side effects?


METHODS
Bench and animal studies in a university hospital laboratory.


METHODS
A lung model was ventilated via single and double-lumen ETTs. Closed-system suctioning was applied with catheters introduced into the single-lumen ETT or the expiratory lumen of the double-lumen ETT via swivel adapter. Seven anesthetized pigs (lungs lavaged) underwent three runs of ventilation and suctioning through (a, b) an 8.0-mm ID single-lumen ETT, (c) a double-lumen ETT (41Ch outer diameter, OD). In (a) the single-lumen ETT was disconnected for suctioning, in (b) and (c) ventilator mode was set to continuous positive airway pressure mode, and the ETTs remained connected.


RESULTS
Bench: Suction through single-lumen ETTs impaired ventilation and led to strongly negative P(tr) (common: -10 to -20 mbar); the double-lumen ETT technique maintained ventilation and pressures.


METHODS
Lung gas content (computed tomography, n=4) and arterial oxygen partial pressure, initially 1462+/-65 ml/532+/-76 mmHg, were significantly reduced by suctioning through single-lumen ETT: to 302+/-79 ml/62+/-6 mmHg with disconnection and to 851+/-211 ml/158+/-107 mmHg with closed suction. With double-lumen ETT they remained at 1377+/-95 ml/521+/-56 mmHg.


CONCLUSIONS
The double-lumen ETT technique minimizes side effects of suctioning by maintaining P(tr).
Reissmann
Hajo
H
Department of Anesthesiology, Universitätsklinikum Hamburg-Eppendorf, Germany. reissmann@uke.uni-hamburg.de
Böhm
Stephan H
SH
Suárez-Sipmann
Fernando
F
Tusman
Gerardo
G
Buschmann
Claas
C
Maisch
Stefan
S
Pesch
Tanja
T
Thamm
Oliver
O
Plümers
Christoph
C
Schulte am Esch
Jochen
J
Hedenstierna
Göran
G
D000818:Animals; D004195:Disease Models, Animal; D004867:Equipment Design; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods*; D008954:Models, Biological; D010313:Partial Pressure; D011650:Pulmonary Alveoli / Q000503:physiopathology*; D001261:Pulmonary Atelectasis / Q000503:physiopathology / Q000517:prevention & control*; D013396:Suction / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome