Intensive Care Unit, University of Health Sciences Turkey, İzmir School of Medicine, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey.
Department of Physiotherapy, University of Health Sciences Turkey, İzmir School of Medicine, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey.
Korean J Anesthesiol. 2024 Feb;77(1):115-121. doi: 10.4097/kja.23194. Epub 2023 May 22.
Alveoli tend to collapse in patients with acute respiratory distress syndrome (ARDS). Endotracheal aspiration may increase alveolar collapse due to the loss of end-expiratory lung volume (EELV). We aimed to compare the loss of EELV after open and closed suction in patients with ARDS.
This randomized crossover study included 20 patients receiving invasive mechanical ventilation for ARDS. Open and closed suction were applied in a random order. Lung impedance was measured using electric impedance tomography. The change in end-expiratory lung impedance end of suction and at 1, 10, 20, and 30 min after suction, was used to represent the change in EELV. Arterial blood gas analyses and ventilatory parameters such as the plateau pressure (Pplat), driving pressure (Pdrive), and compliance of the respiratory system (CRS) were also recorded.
Less volume loss was noted after closed suction than after open suction (mean ΔEELI: -2661 ± 1937 vs. -4415 ± 2363; mean difference: -1753; 95% CI [-2662, -844]; P = 0.001). EELI returned to baseline 10 min after closed suction but did not return to baseline even 30 min after open suction. After closed suction, the Pplat and Pdrive decreased while the CRS increased. Conversely, the Pplat and Pdrive increased while the CRS decreased after open suction.
Endotracheal aspiration may result in alveolar collapse due to loss of EELV. Given that closed suction is associated with less volume loss at end-expiration without worsening ventilatory parameters, it should be chosen over open suction in patients with ARDS.
急性呼吸窘迫综合征（ARDS）患者的肺泡容易塌陷。由于呼气末肺容积（EELV）的丢失，经气管内吸引可能会导致肺泡进一步塌陷。我们旨在比较 ARDS 患者行开放式和密闭式吸痰后 EELV 的丢失情况。
这是一项随机交叉研究，纳入了 20 例接受有创机械通气治疗的 ARDS 患者。以随机顺序应用开放式和密闭式吸痰。使用电阻抗断层成像术测量肺阻抗。以吸痰结束时和吸痰后 1、10、20 和 30 分钟时的肺阻抗呼气末变化来代表 EELV 的变化。还记录了动脉血气分析和通气参数，如平台压（Pplat）、驱动压（Pdrive）和呼吸系统顺应性（CRS）。
密闭式吸痰后 EELV 的丢失量较开放式吸痰少（平均ΔEELI：-2661 ± 1937 比-4415 ± 2363；平均差值：-1753；95%CI[-2662，-844]；P=0.001）。密闭式吸痰后 10 分钟 EELI 恢复至基线水平，但开放式吸痰后 30 分钟仍未恢复至基线水平。密闭式吸痰后，Pplat 和 Pdrive 降低而 CRS 增加。相反，开放式吸痰后，Pplat 和 Pdrive 增加而 CRS 降低。
经气管内吸引可能会导致 EELV 丢失，从而引起肺泡塌陷。鉴于密闭式吸痰在不恶化通气参数的情况下，与呼气末更小的容量丢失相关，因此在 ARDS 患者中，应选择密闭式吸痰而非开放式吸痰。
