Department of Anaesthesiology and Intensive Care, Gødstrup Hospital, Herning, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Respir Care. 2023 Nov;68(11):1502-1509. doi: 10.4187/respcare.10850. Epub 2023 Apr 28.
Endotracheal suctioning is resource demanding, causes patient discomfort, and is associated with adverse effects. A new artificial cough method has been developed for automated secretion removal by using rapid deflation and inflation of the endotracheal tube cuff during the inspiratory phase of mechanical ventilation. This method has been evaluated in a bench model and in animals but not in human subjects. The aim of this study was to investigate whether this method can remove the need for endotracheal suctioning in subjects and whether this is dependent on ventilator settings.
This prospective, non-controlled study recruited 20 subjects on invasive mechanical ventilation. On the clinical need for endotracheal suctioning, the automatic cough procedure was applied 3 times over 30 s, with this repeated at higher ventilatory pressure and lower respiratory frequency if considered unsuccessful. Success was determined by removal of the clinical need for suctioning. Subject safety and comfort was measured by using the Critical-Care Pain Observation Tool before and after the procedure, and negative effects were recorded. To assess intra-subject variability, the procedure was performed on 3 different occasions for each subject.
The procedure was successful in 18 of 20 subjects (90%), with mean subject success rates of 53% at low settings (peak inspiratory pressure 21.8 ± 3.8 cm HO) and 83% at high settings (peak inspiratory pressure 25.6 ± 3.6 cm HO). The Critical-Care Pain Observation Tool category remained unchanged in 30 procedures (77%), improved in 7 (18%), and deteriorated in 2 (5%).
This study illustrated the potential for significant reduction in the clinical need for endotracheal suctioning after the use of an automated artificial cough procedure at both low and high peak inspiratory pressures, and that was well tolerated.
经气管吸引是一种资源密集型操作，会引起患者不适，并可能带来不良影响。一种新的人工咳嗽方法已经被开发出来，通过在机械通气的吸气相期间快速放气和充气来自动清除分泌物。该方法已经在模型和动物中进行了评估，但尚未在人体中进行评估。本研究的目的是评估该方法是否可以减少患者对经气管吸引的需求，以及这是否依赖于呼吸机设置。
这是一项前瞻性、非对照研究，共纳入 20 名接受有创机械通气的患者。当临床需要进行经气管吸引时，应用自动咳嗽程序 3 次，每次 30 秒，如果认为不成功，则在更高的通气压力和更低的呼吸频率下重复该程序。成功的标准是消除临床需要吸引的情况。在操作前后使用关键护理疼痛观察工具（Critical-Care Pain Observation Tool）测量患者的安全性和舒适度，并记录不良事件。为了评估个体内的变异性，每个患者在 3 个不同的场合进行了该程序。
该程序在 20 名患者中的 18 名（90%）中成功，低设置（吸气峰压 21.8 ± 3.8 cm HO）时的平均患者成功率为 53%，高设置（吸气峰压 25.6 ± 3.6 cm HO）时的平均患者成功率为 83%。30 次操作中有 30 次（77%）的关键护理疼痛观察工具分类保持不变，7 次（18%）得到改善，2 次（5%）恶化。
本研究表明，在低和高吸气峰压下使用自动人工咳嗽程序后，显著减少了经气管吸引的临床需求，且耐受性良好。
