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Respiratory Care Feb 2022Artificial airway suctioning is a key component of airway management and a core skill for clinicians charged with assuring airway patency. Suctioning of the artificial...
Artificial airway suctioning is a key component of airway management and a core skill for clinicians charged with assuring airway patency. Suctioning of the artificial airway is a common procedure performed worldwide on a daily basis. As such, it is imperative that clinicians are familiar with the most-effective and efficient methods to perform the procedure. We conducted a systematic review to assist in the development of evidence-based recommendations that pertain to the care of patients with artificial airways. From our systematic review, we developed guidelines and recommendations that addressed questions related to the indications, complications, timing, duration, and methods of artificial airway suctioning. By using a modified version of the RAND/UCLA Appropriateness Method, the following recommendations for suctioning were developed for neonatal, pediatric, and adult patients with an artificial airway: (1) breath sounds, visual secretions in the artificial airway, and a sawtooth pattern on the ventilator waveform are indicators for suctioning pediatric and adult patients, and an acute increase in airway resistance may be an indicator for suctioning in neonates; (2) as-needed only, rather than scheduled, suctioning is sufficient for neonatal and pediatric patients; (3) both closed and open suction systems may be used to safely and effectively remove secretions from the artificial airway of adult patients; (4) preoxygenation should be performed before suctioning in pediatric and adult patients; (5) the use of normal saline solution should generally be avoided during suctioning; (6) during open suctioning, sterile technique should be used; (7) suction catheters should occlude < 70% of the endotracheal tube lumen in neonates and < 50% in pediatric and adult patients, and suction pressure should be kept below -120 mm Hg in neonatal and pediatric patients and -200 mm Hg in adult patients; (8) suction should be applied for a maximum of 15 s per suctioning procedure; (9) deep suctioning should only be used when shallow suctioning is ineffective; (10) routine bronchoscopy for secretion removal is not recommended; and (11) devices used to clear endotracheal tubes may be used when airway resistance is increased due to secretion accumulation.
Topics: Adult; Airway Management; Child; Humans; Infant, Newborn; Intubation, Intratracheal; Respiration, Artificial; Suction; Ventilators, Mechanical
PubMed: 35078900
DOI: 10.4187/respcare.09548 -
European Respiratory Review : An... Mar 2022Recently, "Technical standards for respiratory oscillometry" was published, which reviewed the physiological basis of oscillometric measures and detailed the technical... (Review)
Review
Recently, "Technical standards for respiratory oscillometry" was published, which reviewed the physiological basis of oscillometric measures and detailed the technical factors related to equipment and test performance, quality assurance and reporting of results. Here we present a review of the clinical significance and applications of oscillometry. We briefly review the physiological principles of oscillometry and the basics of oscillometry interpretation, and then describe what is currently known about oscillometry in its role as a sensitive measure of airway resistance, bronchodilator responsiveness and bronchial challenge testing, and response to medical therapy, particularly in asthma and COPD. The technique may have unique advantages in situations where spirometry and other lung function tests are not suitable, such as in infants, neuromuscular disease, sleep apnoea and critical care. Other potential applications include detection of bronchiolitis obliterans, vocal cord dysfunction and the effects of environmental exposures. However, despite great promise as a useful clinical tool, we identify a number of areas in which more evidence of clinical utility is needed before oscillometry becomes routinely used for diagnosing or monitoring respiratory disease.
Topics: Airway Resistance; Asthma; Humans; Oscillometry; Respiratory Function Tests; Spirometry
PubMed: 35140105
DOI: 10.1183/16000617.0208-2021 -
Intensive Care Medicine Jun 2020
Topics: Airway Resistance; Betacoronavirus; COVID-19; Comorbidity; Coronavirus Infections; Guidelines as Topic; Humans; Hypoxia; Lung; Lung Compliance; Organ Size; Pandemics; Phenotype; Pneumonia, Viral; Radiography, Thoracic; Respiratory Dead Space; SARS-CoV-2; Severity of Illness Index; Ventilation-Perfusion Ratio
PubMed: 32291463
DOI: 10.1007/s00134-020-06033-2 -
Respiratory Care May 2021In mechanically ventilated subjects, intra-tracheal secretions can be aspirated with either open suction systems (OSS) or closed suction systems (CSS). In contrast to... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In mechanically ventilated subjects, intra-tracheal secretions can be aspirated with either open suction systems (OSS) or closed suction systems (CSS). In contrast to CSS, conventional OSS require temporarily disconnecting the patient from the ventilator, which briefly diminishes PEEP and oxygen supply. On the other hand, CSS are more expensive and less effective at aspirating secretions. Thus, it was hypothesized that the 2 procedures differentially affect pulmonary and cardiovascular parameters after suction.
METHODS
Subjects in the ICU ( = 66) were quasi-randomized for initial treatment with OSS or CSS in a crossover design. To compare the potential for these suction systems to compromise cardiorespiratory stability, changes in cardiopulmonary physiology were assessed from before to just after use of each suction system (three 10-s aspirations).
RESULTS
For most pulmonary and cardiovascular parameters (ie, peak inspiratory pressure, airway resistance, pressure plateau, heart rate, and arterial pressures), the effects of aspiration inversely correlated with baseline values for that parameter, with a similar regression slope between suction systems. However, when controlling for baseline values, OSS caused significantly greater increases in airway resistance and peak inspiratory pressure ( < .001 and < .01 vs CSS, respectively).
CONCLUSIONS
Elevated airway resistance prior to endotracheal suction may justify use of a CSS and contraindicate a conventional OSS in mechanically ventilated subjects. Adoption of this approach into clinical guidelines may prevent suction-induced pulmonary injury in subjects, especially for those with underlying diseases involving increased airway resistance or increased alveolar pressure. (ClinicalTrials.gov registration: NCT03256214.).
Topics: Humans; Intubation, Intratracheal; Respiration, Artificial; Respiratory Physiological Phenomena; Suction; Trachea
PubMed: 33688090
DOI: 10.4187/respcare.08511 -
Otolaryngologic Clinics of North America Jun 2020It is estimated that half of the adult population older than 60 years snores. This article discusses the many aspects of snoring, including impacts on bed partners, the... (Review)
Review
It is estimated that half of the adult population older than 60 years snores. This article discusses the many aspects of snoring, including impacts on bed partners, the individual who snores, and when and how to appropriately evaluate, diagnose, and treat the perpetrator. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of the phenomenon of snoring.It is estimated that half of the adult population over the age of 60 years of age snores. This chapter discusses snoring, including the impact on bed partners, the individual that snores and when and how to treat the snorer. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of patients who snores.
Topics: Airway Obstruction; Humans; Nasopharynx; Nose; Polysomnography; Sleep Apnea, Obstructive; Snoring; Sound Spectrography
PubMed: 32336469
DOI: 10.1016/j.otc.2020.02.011 -
Cardiovascular Toxicology Oct 2019The use of electronic cigarettes has increased exponentially since its introduction onto the global market in 2006. However, short- and long-term health effects remain... (Randomized Controlled Trial)
Randomized Controlled Trial
The use of electronic cigarettes has increased exponentially since its introduction onto the global market in 2006. However, short- and long-term health effects remain largely unknown due to the novelty of this product. The present study examines the acute effects of e-cigarette aerosol inhalation, with and without nicotine, on vascular and pulmonary function in healthy volunteers. Seventeen healthy subjects inhaled electronic cigarette aerosol with and without nicotine on two separate occasions in a double-blinded crossover fashion. Blood pressure, heart rate, and arterial stiffness measured by pulse wave velocity and pulse wave analysis were assessed at baseline, and then at 0 h, 2 h, and 4 h following exposure. Dynamic spirometry and impulse oscillometry were measured following vascular assessments at these time points, as well as at 6 h following exposure. e-Cigarette aerosol with nicotine caused a significant increase in heart rate and arterial stiffness. Furthermore, e-cigarette aerosol-containing nicotine caused a sudden increase in flow resistance as measured by impulse oscillometry, indicating obstruction of the conducting airways. Both aerosols caused an increase in blood pressure. The present study indicates that inhaled e-cigarette aerosol with nicotine has an acute impact on vascular and pulmonary function. Thus, chronic usage may lead to long-term adverse health effects. Further investigation is warranted.
Topics: Administration, Inhalation; Adult; Aerosols; Airway Obstruction; Airway Resistance; Blood Pressure; Cardiovascular System; Cross-Over Studies; Double-Blind Method; Electronic Nicotine Delivery Systems; Female; Healthy Volunteers; Heart Rate; Hemodynamics; Humans; Lung; Male; Nicotine; Nicotinic Agonists; Risk Assessment; Time Factors; Vaping; Vascular Stiffness; Young Adult
PubMed: 30963443
DOI: 10.1007/s12012-019-09516-x