Mechanically ventilated patients periodically require endotracheal suctioning. There are conflicting data regarding the loss of lung gas volume caused by the application of a negative pressure by closed-circuit suctioning. The aim of this study was to evaluate the effects of suctioning performed by a closed-circuit system in ARDS patients during volume- or pressure-controlled ventilation. In this prospective crossover-design study, 18 ARDS patients were ventilated under volume and pressure control applied in random order. Gas exchange, respiratory mechanics and EIT-derived end-expiratory lung volume (EELV) before the suctioning manoeuvre and after 5, 15 and 30 min were recorded. The tidal volume and respiratory rate were similar in both ventilation modes; in volume control, the EELV decreased by 31 ± 23 mL, 5 min after the suctioning, but it remained similar after 15 and 30 min; the oxygenation, PaCO2 and respiratory system elastance did not change. In the pressure control, 5 min after suctioning, EELV decreased by 35 (26–46) mL, the PaO2/FiO2 did not change, while PaCO2 increased by 5 and 30 min after suctioning (45 (40–51) vs. 48 (43–52) and 47 (42–54) mmHg, respectively). Our results suggest minimal clinical advantages when a closed system is used in volume-controlled compared to pressure-controlled ventilation.

Effects on lung gas volume, respiratory mechanics and gas exchange of a closed-circuit suctioning system during volume- and pressure-controlled ventilation in ARDS patients / D. Chiumello, L. Bolgiaghi, P. Formenti, T. Pozzi, M. Lucenteforte, S. Coppola. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 10:23(2021), pp. 5657.1-5657.8. [10.3390/jcm10235657]

Effects on lung gas volume, respiratory mechanics and gas exchange of a closed-circuit suctioning system during volume- and pressure-controlled ventilation in ARDS patients

D. Chiumello
Primo
;
L. Bolgiaghi
Secondo
;
P. Formenti;T. Pozzi;M. Lucenteforte
Penultimo
;
S. Coppola
Ultimo
2021

Abstract

Mechanically ventilated patients periodically require endotracheal suctioning. There are conflicting data regarding the loss of lung gas volume caused by the application of a negative pressure by closed-circuit suctioning. The aim of this study was to evaluate the effects of suctioning performed by a closed-circuit system in ARDS patients during volume- or pressure-controlled ventilation. In this prospective crossover-design study, 18 ARDS patients were ventilated under volume and pressure control applied in random order. Gas exchange, respiratory mechanics and EIT-derived end-expiratory lung volume (EELV) before the suctioning manoeuvre and after 5, 15 and 30 min were recorded. The tidal volume and respiratory rate were similar in both ventilation modes; in volume control, the EELV decreased by 31 ± 23 mL, 5 min after the suctioning, but it remained similar after 15 and 30 min; the oxygenation, PaCO2 and respiratory system elastance did not change. In the pressure control, 5 min after suctioning, EELV decreased by 35 (26–46) mL, the PaO2/FiO2 did not change, while PaCO2 increased by 5 and 30 min after suctioning (45 (40–51) vs. 48 (43–52) and 47 (42–54) mmHg, respectively). Our results suggest minimal clinical advantages when a closed system is used in volume-controlled compared to pressure-controlled ventilation.
ARDS; Closed-circuit suctioning; EIT; Endotracheal suctioning
Settore MED/41 - Anestesiologia
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/897495
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