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Prevention of Endotracheal Suctioning-induced Alveolar Derecruitment in Acute Lung Injury

Department of Anesthesiology and Intensive Care, Agostino Gemelli Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy; Medical Intensive Care Unit, INSERM U492, Henri Mondor Teaching Hospital, AP-HP, Paris XII University, Créteil, France; Medical Intensive Care Unit, Charles Nicolle Teaching Hospital, Rouen, France; and Intensive Care Service, Hospital of the Sacred Cross and Saint Paul, Barcelona, Spain

Correspondence and requests for reprints should be addressed to Prof. L. Brochard, Réanimation Médicale, Hôpital Henri Mondor, 94000 Créteil, France. E-mail: laurent.brochard{at}hmn.ap-hop-paris.fr

We studied endotracheal suctioning-induced alveolar derecruitment and its prevention in nine patients with acute lung injury. Changes in end-expiratory lung volume measured by inductive plethysmography, positive end-expiratory pressure-induced alveolar recruitment assessed by pressure–volume curves, oxygen saturation, and respiratory mechanics were recorded. Suctioning was performed after disconnection from the ventilator, through the swivel adapter of the catheter mount, with a closed system, and with the two latter techniques while performing recruitment maneuvers during suctioning (40 cm H₂O pressure-supported breaths). End-expiratory lung volume after disconnection fell more than with all other techniques (-1,466 ± 586, -733 ± 406, -531 ± 228, -168 ± 176, and -284 ± 317 ml after disconnection, through the swivel adapter, with the closed system, and with the two latter techniques with pressure-supported breaths, respectively, p < 0.001), and was not fully recovered 1 minute after suctioning. Recruitment decreased after disconnection and using the swivel adapter (-104 ± 31 and -63 ± 25 ml, respectively), was unchanged with the closed system (-1 ± 10 ml), and increased when performing recruitment maneuvers during suctioning (71 ± 37 and 60 ± 30 ml) (p < 0.001). Changes in alveolar recruitment correlated with changes in lung volume ( = 0.88, p < 0.001) and compliance ( = 0.9, p < 0.001). Oxygenation paralleled lung volume changes. Suctioning-induced lung derecruitment in acute lung injury can be prevented by performing recruitment maneuvers during suctioning and minimized by avoiding disconnection.

Key Words: acute lung injury • alveolar recruitment • closed suctioning system • endotracheal suctioning • recruitment maneuver

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