Kerem E, Yatsiv I, Goitein K J
Department of Pediatrics, Hadassah University Hospital, Jerusalem, Israel.
Intensive Care Med. 1990;16(2):95-9. doi: 10.1007/BF02575301.
The occurrence of hypoxia during endotracheal tube suctioning and its prevention was examined in 25 hemodynamically stable and non-cyanosed pediatric patients. In each patient 4 suction and treatment protocols were studied: 1. pre- and post-suction arterial blood gases (ABG) with no treatment (control). 2. ABG with pre-suction oxygenation. 3. ABG with presuction hyperinflation. 4. ABG with postsuction hyperinflation. With no presuction treatment the PO2 and saturation fell significantly after suctioning from control level of 116.6 +/- 9.4 mmHg to 93 +/- 9.3 mmHg post-suction and 97.2 +/- 0.4% to 92.8 +/- 1.4% (p less than 0.001) respectively. In 6 patients with low but adequate pre-suction PO2, hypoxic levels (PO2 less than 60 mmHg) were found post-suction. The significant fall in PO2 was completely prevented by pre-suction oxygenation. Post-suction hyperinflation induced a rapid return of the PO2 to control levels. These results suggest that severe hypoxia might occur during endotracheal suctioning and can be prevented by pre-oxygenation. We recommend 1 min oxygenation with FiO2 1.0 prior to suctioning procedures and intermittent hyperinflation with 100% oxygen during repeated endotracheal suction passes to prevent hypoxia, especially in children in respiratory failure who already have low or borderline pre-suction PO2.
对25例血流动力学稳定且无发绀的儿科患者进行了气管内吸痰期间低氧血症的发生情况及其预防的研究。对每位患者研究了4种吸痰和治疗方案：1. 吸痰前后动脉血气（ABG），不进行治疗（对照）。2. 吸痰前给氧的ABG。3. 吸痰前肺过度充气的ABG。4. 吸痰后肺过度充气的ABG。在未进行吸痰前治疗的情况下，吸痰后PO₂和饱和度从对照水平的116.6±9.4 mmHg显著下降至93±9.3 mmHg，饱和度从97.2±0.4%降至92.8±1.4%（p＜0.001）。在6例吸痰前PO₂低但足够的患者中，吸痰后发现了低氧水平（PO₂＜60 mmHg）。吸痰前给氧完全预防了PO₂的显著下降。吸痰后肺过度充气使PO₂迅速恢复到对照水平。这些结果表明，气管内吸痰期间可能会发生严重低氧血症，并且可以通过预给氧来预防。我们建议在吸痰操作前用1.0的FiO₂进行1分钟给氧，并在反复进行气管内吸痰时用100%氧气进行间歇性肺过度充气，以预防低氧血症，尤其是对于那些吸痰前PO₂已经较低或处于临界值的呼吸衰竭儿童。
