The effect of closed system suction on airway pressures when using the Servo 300 ventilator.
OBJECTIVE
To measure airway pressures during closed system suctioning with the ventilator set to three differing modes of ventilation.


METHODS
Closed system suctioning was conducted in 16 patients following cardiac surgery. Suctioning was performed using a 14 French catheter with a vacuum level of -500 cmH2O through an 8.0 mm internal diameter endotracheal tube. The lungs were mechanically ventilated with a Servo 300 ventilator set to one of three ventilation modes: volume-control, pressure-control or CPAP/pressure support. Airway pressures were measured via a 4 French electronic pressure transducer in both proximal and distal airways.


RESULTS
Following insertion of the suction catheter, end-expiratory pressure increased significantly (p < 0.001) in both pressure-control and volume-control ventilation. This increase was greatest (p = 0.018) in volume-control mode (2.7 +/- 1.7 cmH2O). On performing a five second suction, airway pressure decreased in all modes, however the lowest airway pressure in volume-control mode (-4.9 +/- 4.0 cmH2O) was significantly (p = 0.001) less than the lowest airway pressure recorded in either pressure-control (0.8 +/- 1.9 cmH2O) or CPAP/pressure support (0.4 +/- 2.8 cmH2O) modes. In CPAP/pressure support mode, 13 of the 16 patients experienced a positive pressure 'breath' at the end of suctioning with airway pressures rising to 21 +/- 1.6 cmH2O.


CONCLUSIONS
Closed system suctioning in volume control ventilation may result in elevations of end-expiratory pressure following catheter insertion and subatmospheric airway pressures during suctioning. Pressure control ventilation produces less elevation of end-expiratory pressure following catheter insertion and is less likely to be associated with subatmospheric airway pressures during suctioning. CPAP/pressure support has no effect on end-expiratory pressure following catheter insertion and subatmospheric airway pressures are largely avoided during suctioning.
Department of Intensive Care, Waikato Hospital, Hamilton, New Zealand. frengler@hwl.co.nz
R W
RW
Frengley
D N
DN
Closey
J W
JW
Sleigh
J M
JM
Torrance