Effects of combined tracheal suctioning and expiratory pause: A crossover randomized clinical trial

Abstract

Aims: Our aim is to compare volume of suctioned secretion, respiratory mechanics, and hemodynamic parameters in intubated patients undergoing closed-system endotracheal suctioning alone (control group) versus closed-system tracheal suctioning with an expiratory pause (intervention group). Settings and design: Randomized crossover clinical trial. Materials and methods: Patients who had been on mechanical ventilation for more than 24 hours were randomly assigned to receive closedsystem suctioning alone or closed-system suctioning with an expiratory pause on the ventilator. The following variables were evaluated: Heart rate, respiratory rate, mean arterial pressure, peripheral arterial oxygen saturation, peak inspiratory pressure, mechanical ventilator circuit pressure during aspiration, exhaled tidal volume, dynamic compliance, resistance, and weight of suctioned secretion. Statistical analysis: Compared using the paired t-test and general linear model analysis of variance for normally distributed variables (as confirmed by the Kolmogorov-Smirnov test). The Wilcoxon test was used for variables with a nonparametric distribution, while the Chi-square test and Fisher’s exact test were used for categorical variables. Results: The sample comprised 31 patients (mean age, 61.1 ±18.2 years). The amount of secretion suctioned was significantly higher in the intervention group than in the control group (1.6 g vs 0.45 g; p = 0.0001). There were no significant changes in hemodynamic parameters or respiratory mechanics when comparing pre- and postprocedure time points. Conclusion: The combination of closed-system endotracheal suctioning and an expiratory pause significantly increased the amount of secretion suctioned compared to conventional suctioning without expiratory pause.