title: Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice.
abstract: BACKGROUND
  Little is known about the incidence of and risk factors for adverse effects from endotracheal suctioning. We studied the incidence and risk factors, and evaluated the effect of suctioning practice guidelines.
  
  
  METHODS
  During a 3-month period, in 79 mechanically ventilated subjects, we recorded the adverse effects in 4,506 suctioning procedures. Then practice guidelines were implemented, and 1 year later, during another 3-month period, in 68 subjects, we recorded the adverse effects in 4,994 suctioning procedures.
  
  
  RESULTS
  In the first period, adverse effects occurred frequently: oxygen desaturation in 46.8% of subjects and 6.5% of suctionings, hemorrhagic secretions in 31.6% of subjects and 4% of suctionings, blood pressure change in 24.1% of subjects and 1.6% of suctionings, and heart rate change in 10.1% of subjects and 1.1% of suctionings. After guidelines implementation, all complications, both separately and all together, were reduced. The incidence of all complications together decreased from 59.5% to 42.6% of subjects, and from 12.4% to 4.9% of procedures (both P < .05). PEEP > 5 cm H2O was an independent risk factor for oxygen desaturation. Receiving > 6 suctionings per day was a risk factor for desaturation and hemorrhagic secretions. The use of guidelines was independently associated with fewer complications.
  
  
  CONCLUSIONS
  Endotracheal suctioning frequently induces adverse effects. Technique, suctioning frequency, and higher PEEP are risk factors for complications. Their incidence can be reduced by the implementation of suctioning guidelines.
authors: Department of Anesthesiology and Intensive Care, Agostino Gemelli Hospital, Catholic University of the Sacred Heart, Rome, Italy.
authors: Salvatore Maurizio
authors: SM
authors: Maggiore
authors: François
authors: F
authors: Lellouche
authors: Claudia
authors: C
authors: Pignataro
authors: Emmanuelle
authors: E
authors: Girou
authors: Bernard
authors: B
authors: Maitre
authors: Jean-Christophe M
authors: JC
authors: Richard
authors: François
authors: F
authors: Lemaire
authors: Christian
authors: C
authors: Brun-Buisson
authors: Laurent
authors: L
authors: Brochard
mesh_terms: D000402:Airway Obstruction / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D013396:Suction / Q000009:adverse effects* / Q000592:standards*
keywords: ARDS; PEEP; closed suctioning system; endotracheal suctioning; mechanical ventilation; practice guidelines