A Closed-Suction Catheter with a Pressure Valve Can Reduce Tracheal Mucosal Injury in Intubated Patients
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Background: Endotracheal suctioning is associated with complications that include bleeding, infection, hypoxemia, cardiovascular instability, and tracheal mucosal injury. Recently, a closed-suction catheter with a pressure valve (Acetrachcare, AceMedical Co., Republic of Korea) was developed. We hypothesized that this new catheter might reduce tracheal mucosal injury compared to a conventional closed-suction catheter (Trachcare, Kimberly-balla RD, USA). Methods: This prospective, randomized study enrolled medical and surgical patients who required mechanical ventilation for more than 48 hours. Patients were randomized into two groups: one group was suctioned with the conventional closed-suction catheter (CCC) and the other group was suctioned with the closed-suction catheter with pressure valve (CCPV). Bronchoscopy was performed 48 hours later, and the severity of tracheal mucosal injury was graded on a 5-point scale, as follows: 0 = normal; 1 = erythema or edema; 2 = erosion; 3 = hemorrhage; and 4 = ulceration or necrosis. Results: A total of 76 patients (37 with CCPV and 39 with CCC) were included. There were no significant differences between the groups regarding demographic characteristics, changes in hemodynamic parameters during suction, incidence of pneumonia, length of intensive care unit (ICU) stay, or ICU mortality. On bronchoscopic evaluation, the use of the CCPV led to a significant decrease in tracheal mucosal injury (median tracheal mucosal injury grade 1 [IQR 0-1] vs. 2 [IQR 1-3], p = 0.001). Conclusions: We conclude that the novel closed-suction catheter with pressure valve may reduce tracheal mucosal injury compared to conventional catheters.
Abstract
Background: Endotracheal suctioning is associated with complications that include bleeding, infection, hypoxemia, cardiovascular instability, and tracheal mucosal injury. Recently, a closed-suction catheter with a pressure valve (Acetrachcare, AceMedical Co., Republic of Korea) was developed. We hypothesized that this new catheter might reduce tracheal mucosal injury compared to a conventional closed-suction catheter (Trachcare, Kimberly-balla RD, USA). Methods: This prospective, randomized study enrolled medical and surgical patients who required mechanical ventilation for more than 48 hours. Patients were randomized into two groups: one group was suctioned with the conventional closed-suction catheter (CCC) and the other group was suctioned with the closed-suction catheter with pressure valve (CCPV). Bronchoscopy was performed 48 hours later, and the severity of tracheal mucosal injury was graded on a 5-point scale, as follows: 0 = normal; 1 = erythema or edema; 2 = erosion; 3 = hemorrhage; and 4 = ulceration or necrosis. Results: A total of 76 patients (37 with CCPV and 39 with CCC) were included. There were no significant differences between the groups regarding demographic characteristics, changes in hemodynamic parameters during suction, incidence of pneumonia, length of intensive care unit (ICU) stay, or ICU mortality. On bronchoscopic evaluation, the use of the CCPV led to a significant decrease in tracheal mucosal injury (median tracheal mucosal injury grade 1 [IQR 0-1] vs. 2 [IQR 1-3], p = 0.001). Conclusions: We conclude that the novel closed-suction catheter with pressure valve may reduce tracheal mucosal injury compared to conventional catheters.
참고문헌 (20)
- Brandstater B, "Atelectasis following tracheal suction in infants", Anesthesiology, 31, pp.468~473 (1969)
- Cabal L, "New endotracheal tube adaptor reducing cardiopulmonary effects of suctioning", Crit Care Med, 7, pp.552~555 (1979)
- Simbruner G, "Effect of tracheal suction on oxygenation, circulation, and lung mechanics in newborn infants", Arch Dis Chil, 56, pp.326~330 (1981)
- American Association for Respiratory Care, "AARC clinical practice guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010", Respir Care, 55, pp.758~764 (2010)
- Shim C, "Cardiac arrhythmias resulting from tracheal suctioning", Ann Intern Med, 71, pp.1149~1153 (1969)
- Johnson KL, "Closed versus open endotracheal suctioning:Costs and physiologic consequences", Crit Care Med, 22, pp.658~666 (1994)
- Cereda M, "Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation", Intensive Care Med, 27, pp.648~654 (2001)
- Maggiore SM, "Prevention of endotracheal suctioning-induced alveolar derecruitment in acute lung injury", Am J Respir Crit Care Med, 167, pp.1215~1224 (2003)
- 이은숙, "폐쇄형 흡인술이 인공호흡기 환자의 산소포화도, 인공호흡기 관련 폐렴 및 흡인간호 효율성에 미치는 영향", Journal of Korean Academy of Nursing, 34(7), pp.1315~1325 (2004), 한국간호과학회
- 차경숙, "기관 흡인술 유형에 따른 인공호흡기 적용 환자의 기관 내 균집락화와 폐렴 발생률", Journal of Korean Academy of Nursing, 41(2), pp.175~181 (2011), 한국간호과학회
- 오지웅, "기관내관 흡인 방법에 따른 반정량적 객담배양검사 결과의 양상 비교", 대한중환자의학회지, 27(2), pp.70~74 (2012), 대한중환자의학회[DOI]
- Jongerden IP, "Changes in heart rate, mean arterial pressure, and oxygen saturation after open and closed endotracheal suctioning: A prospective observational study", J Crit Care, 27, pp.647~654 (2012)
- Lorente L, "Ventilator-associated pneumonia using a closed versus an open tracheal suction system", Crit Care Med, 33, pp.115~119 (2005)
- Siempos, II, "Closed tracheal suction systems for prevention of ventilator-associated pneumonia", Br J Anaesth, 100, pp.299~306 (2008)
- Link WJ, "The influence of suction catheter tip design on tracheobronchial trauma and fluid aspiration efficiency", Anesth Analg, 55, pp.290~297 (1976)
- Burton G, "Respiratory care: a guideline to clinical practice", pp.555~609 (1997), Lippincott Williams &Wilkins
- Blackwood B, "The practice and perception of intensive care staff using the closed suctioning system", J Adv Nurs, 28, pp.1020~1029 (1998)
- Lindgren S, "Effectiveness and side effects of closed and open suctioning: An experimental evaluation", Intensive Care Med, 30, pp.1630~1637 (2004)
- Lasocki S, "Open and closed-circuit endotracheal suctioning in acute lung injury: Efficiency and effects on gas exchange", Anesthesiology, 104, pp.39~47 (2006)
- Ramanathan S, "Humidification and airway pressures during high-frequency jet ventilation delivered through the suction-biopsy channel of a flexible bronchofiberscope", Crit Care Med, 12, pp.820~823 (1984)