Published ahead of print on February 13, 2003, doi:10.1164/rccm.200203-195OC Am. J. Respir. Crit. Care Med., Volume 167, Number 9, May 2003, 1215-1224 A more recent version of this article appeared on May 1, 2003
Submitted on March 12, 2002 Prevention of Endotracheal Suctioning-induced Alveolar Derecruitment in Acute Lung InjurySalvatore M Maggiore1,1 Anesthesiology and Intensive Care, Agostino Gemelli Teaching Hospital, Universita Cattolica del Sacro Coure, Rome, Italy, 2 Medical Intensive Care Unit, Institut National de la Sante et de la Recherche Medicale, Henri Mondor Teaching Hospital, Assistance Publique des Hopitaux de Paris, Paris XII University, Creteil, France, 3 Medical Intensive Care Unit, Charles Nicolle Teaching Hospital, Rouen, France, 4 Servei de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain * To whom correspondence should be addressed. 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, PEEP-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 catheter mount, with a closed system, and with the two latter techniques while performing recruitment maneuvers during suctioning (40 cmH2O pressure-supported breaths). End-expiratory lung volume after disconnection fell more than with all other techniques (-1466±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-min 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 (rho=0.88, P<0.001) and compliance (rho=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: endotracheal suctioning, alveolar recruitment, closed suctioning system, recruitment maneuver, acute lung injury
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