Morrow Brenda, Futter Merle, Argent Andrew
Physiotherapy Department, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
Aust J Physiother. 2006;52(2):121-6. doi: 10.1016/s0004-9514(06)70047-2.
Endotracheal suctioning is performed regularly in ventilated infants and children to remove obstructive secretions. The effect of suctioning on respiratory mechanics is not known. This study aimed to determine the immediate effect of endotracheal suctioning on dynamic lung compliance, tidal volume, and airway resistance in mechanically-ventilated paediatric patients by means of a prospective observational clinical study. Lung mechanics were recorded for five minutes before and five minutes after a standardised suctioning procedure in 78 patients intubated with endotracheal tubes < or = 4.0 mm internal diameter. Twenty-four patients with endotracheal tube leaks > or = 20% were excluded from analysis. There was a significant overall decrease in dynamic compliance (p < 0.001) and mechanical expired tidal volume (p = 0.03) following suctioning with no change in the percentage endotracheal tube leak (p = 0.41). The change in dynamic compliance was directly related to both endotracheal tube and catheter sizes. There was no significant change in expiratory or inspiratory airway resistance following suctioning (p > 0.05). Although the majority of patients (68.5%) experienced a drop in dynamic compliance following suctioning, dynamic compliance increased in 31.5% of patients after the procedure. This study demonstrates that endotracheal suctioning frequently causes an immediate drop in dynamic compliance and expired tidal volume in ventilated children with variable lung pathology, intubated with small endotracheal tubes, probably indicating loss of lung volume caused by the suctioning procedure. There is no evidence that suctioning reduces airway resistance.
在接受机械通气的婴幼儿中，需定期进行气管内吸痰以清除阻塞性分泌物。吸痰对呼吸力学的影响尚不清楚。本研究旨在通过一项前瞻性观察性临床研究，确定气管内吸痰对机械通气儿科患者动态肺顺应性、潮气量和气道阻力的即时影响。对78例内径≤4.0mm气管插管的患者，在标准化吸痰操作前5分钟和操作后5分钟记录肺力学指标。24例气管插管漏气≥20%的患者被排除在分析之外。吸痰后动态顺应性（p<0.001）和机械呼气潮气量（p=0.03）总体显著下降，气管插管漏气百分比无变化（p=0.41）。动态顺应性的变化与气管插管和导管尺寸均直接相关。吸痰后呼气或吸气气道阻力无显著变化（p>0.05）。尽管大多数患者（68.5%）吸痰后动态顺应性下降，但31.5%的患者吸痰后动态顺应性增加。本研究表明，气管内吸痰常导致肺病理情况各异、使用小口径气管插管的机械通气儿童的动态顺应性和呼气潮气量即时下降，这可能表明吸痰操作导致肺容积减少。没有证据表明吸痰可降低气道阻力。
