title: Suctioning through a double-lumen endotracheal tube helps to prevent alveolar collapse and to preserve ventilation.
abstract: 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).
authors.affiliation: Department of Anesthesiology, Universitätsklinikum Hamburg-Eppendorf, Germany. reissmann@uke.uni-hamburg.de
authors.forename: Hajo
authors.initials: H
authors.lastname: Reissmann
authors.forename: Stephan H
authors.initials: SH
authors.lastname: Böhm
authors.forename: Fernando
authors.initials: F
authors.lastname: Suárez-Sipmann
authors.forename: Gerardo
authors.initials: G
authors.lastname: Tusman
authors.forename: Claas
authors.initials: C
authors.lastname: Buschmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Maisch
authors.forename: Tanja
authors.initials: T
authors.lastname: Pesch
authors.forename: Oliver
authors.initials: O
authors.lastname: Thamm
authors.forename: Christoph
authors.initials: C
authors.lastname: Plümers
authors.forename: Jochen
authors.initials: J
authors.lastname: Schulte am Esch
authors.forename: Göran
authors.initials: G
authors.lastname: Hedenstierna
mesh_terms: 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