Prevention of Endotracheal Suctioning-induced Alveolar Derecruitment in Acute Lung Injury

TLDR

The study examined how to prevent alveolar derecruitment caused by endotracheal suctioning in nine acute lung injury patients. End‑expiratory lung volume, recruitment, oxygen saturation, and respiratory mechanics were measured while suctioning was performed after ventilator disconnection, via a swivel adapter, with a closed system, and with pressure‑supported recruitment maneuvers. Disconnection caused the greatest loss of end‑expiratory lung volume and recruitment, whereas closed‑system suction and recruitment maneuvers during suctioning preserved lung volume and recruitment, indicating that recruitment maneuvers during suctioning prevent derecruitment and disconnection should be avoided.

Abstract

We studied endotracheal suctioning-induced alveolar derecruitment and its prevention in nine patients with acute lung injury. Changes in end-expiratory lung volume measured by inductive plethysmography, positive end-expiratory pressure-induced alveolar recruitment assessed by pressure–volume curves, oxygen saturation, and respiratory mechanics were recorded. Suctioning was performed after disconnection from the ventilator, through the swivel adapter of the catheter mount, with a closed system, and with the two latter techniques while performing recruitment maneuvers during suctioning (40 cm H2O pressure-supported breaths). End-expiratory lung volume after disconnection fell more than with all other techniques (−1,466 ± 586, −733 ± 406, −531 ± 228, −168 ± 176, and −284 ± 317 ml after disconnection, through the swivel adapter, with the closed system, and with the two latter techniques with pressure-supported breaths, respectively, p < 0.001), and was not fully recovered 1 minute after suctioning. Recruitment decreased after disconnection and using the swivel adapter (−104 ± 31 and −63 ± 25 ml, respectively), was unchanged with the closed system (−1 ± 10 ml), and increased when performing recruitment maneuvers during suctioning (71 ± 37 and 60 ± 30 ml) (p < 0.001). Changes in alveolar recruitment correlated with changes in lung volume (ρ = 0.88, p < 0.001) and compliance (ρ = 0.9, p < 0.001). Oxygenation paralleled lung volume changes. Suctioning-induced lung derecruitment in acute lung injury can be prevented by performing recruitment maneuvers during suctioning and minimized by avoiding disconnection.