Sole Mary Lou, Bennett Melody, Ashworth Suzanne
Mary Lou Sole is Orlando Health Distinguished Professor and Pegasus Professor, University of Central Florida, College of Nursing, Orlando, Florida, and a research scientist at Orlando Health, Orlando, Florida. Melody Bennett is a member of the adjunct faculty at the University of Central Florida and a clinical research coordinator at Orlando Health. Suzanne Ashworth is a clinical nurse specialist in neurological critical care at Orlando Regional Medical Center, Orlando, Florida.
Am J Crit Care. 2015 Jul;24(4):318-24; quiz 325. doi: 10.4037/ajcc2015794.
Critically ill patients who need mechanical ventilation require endotracheal suctioning. Guidelines recommend coarse crackles over the trachea and/or the presence of a sawtooth pattern on the flow-volume loop of the ventilator waveform as the best indicators.
To determine clinical cues for endotracheal suctioning in patients who require mechanical ventilation.
A descriptive study of 42 adult patients receiving mechanical ventilation. After baseline endotracheal suctioning with a closed-system device, patients were assessed hourly up to 4 hours for guideline-based cues for endotracheal suctioning and lung sounds were auscultated. Endotracheal suctioning was done when cues were detected or 4 hours after baseline suctioning. Secretions were collected, measured, and weighed.
Most patients were male (62%) and white (93%). Mean age was 51 years, and mean duration of mechanical ventilation was 7.5 days. The median time to endotracheal suctioning was 2 hours, and a mean of 4.4 mL of secretions was removed. Three patients had no cues identified but had 1.0 mL or more of secretions. The most frequent cues were crackles over the trachea (88%), sawtooth waveform (33%), coughing (29%), and visible secretions (5%). Cues resolved and physiological parameters improved after suctioning. Coarse lung sounds did not improve.
Patients receiving mechanical ventilation should be routinely assessed for coarse crackles over the trachea, the most common indicator for endotracheal suctioning. Despite common practice, assessment of lung sounds to identify the need for suctioning is not supported.
需要机械通气的重症患者需要进行气管内吸痰。指南推荐气管上方出现粗湿啰音和/或呼吸机波形流量-容积环上出现锯齿样波形作为最佳指标。
确定需要机械通气患者气管内吸痰的临床线索。
对42例接受机械通气的成年患者进行描述性研究。使用密闭系统装置进行基线气管内吸痰后，每小时对患者进行评估，持续4小时，以寻找基于指南的气管内吸痰线索，并听诊肺部声音。当检测到线索或在基线吸痰后4小时进行气管内吸痰。收集、测量并称重分泌物。
大多数患者为男性（62%），白人（93%）。平均年龄为51岁，机械通气平均持续时间为7.5天。气管内吸痰的中位时间为2小时，平均吸出分泌物4.4 mL。3例患者未发现线索，但有1.0 mL或更多分泌物。最常见的线索是气管上方的湿啰音（88%）、锯齿样波形（33%）、咳嗽（29%）和可见分泌物（5%）。吸痰后线索消失，生理参数改善。粗啰音未改善。
接受机械通气的患者应常规评估气管上方的粗湿啰音，这是气管内吸痰最常见的指标。尽管这是常见做法，但通过听诊肺部声音来确定是否需要吸痰并无依据。
