The Effects of Endotracheal Suctioning on Hemodynamic Parameters and Tissue Oxygenation in Pediatric Intensive Care Unit

Abstract

Airway secretions may increase in intubated patients due to the impaired mucociliary clearance, impaired cough reflex, abnormal glottic function, insufficient moisturizing, and respiratory tract infections. As with any intervention, patients should be cautiously monitored for possible complications during the endotracheal suctioning. Procedure-related changes in the cerebral and somatic tissue oxygenation, hemodynamics, and oxygen saturation can be observed in these patients. It is important to ensure maintenance of tissue oxygenation during these and other interventions performed in critically ill children. The aim of this study was to investigate the effects of the endotracheal suctioning on tissue oxygenation in patients undergoing mechanical ventilation in the pediatric intensive care unit. Cerebral and somatic near-infrared spectroscopy (NIRS) monitoring were performed noninvasively using standardized NIRS equipment as a means of monitoring regional tissue oxygenation. Vital signs, level of sedation, pain scores, and somatic and cerebral tissue oxygenation values of mechanically ventilated patients were recorded prospectively 5 minutes before, during, and after endotracheal suctioning. Cerebral NIRS measurements did not exhibit any statistically significant changes during endotracheal suctioning. Somatic NIRS levels changed significantly before, during, and after endotracheal suctioning and remained low throughout the procedure. Endotracheal suctioning is an invasive intervention that facilitates clearance of tracheal secretions and maintenance of the oxygenation and ventilation. The maintenance of the tissue oxygenation should be documented during these and other interventions performed on critically ill children. Somatic NIRS is a useful tool for monitoring tissue oxygenation during such procedures.

Keywords

endotracheal suctioning - somatic oxygenation - cerebral - near-infrared spectroscopy

Publication History

Received: 03 August 2020

Accepted: 09 November 2020

Article published online:
04 January 2021

• References

• 1 Schults JA, Long DA, Mitchell ML. et al. Adverse events and practice variability associated with paediatric endotracheal suction: an observational study. Aust Crit Care 2019; 18: 1036-7314
• 2 Schults J, Mitchell ML, Cooke M, Schibler A. Efficacy and safety of normal saline instillation and paediatric endotracheal suction: an integrative review. Aust Crit Care 2018; 31 (01) 3-9
• 3 Beyrut D, Basbakkal Z. Sedation assessment and use of the Comfort Scale in pediatric intensive care units. J Turk Soc Crit Care Nurs 2013; 17: 52-58
• 4 Celik S. Pain management in intensive care patients. J Turk Soc Crit Care Nurs 2016; 20: 1-8
• 5 Drayna PC, Abramo TJ, Estrada C. Near-infrared spectroscopy in the critical setting. Pediatr Emerg Care 2011; 27 (05) 432-439 , quiz 440–442
• 6 Morrow BM, Argent AC. A comprehensive review of pediatric endotracheal suctioning: Effects, indications, and clinical practice. Pediatr Crit Care Med 2008; 9 (05) 465-477
• 7 Chegondi M, Francis T, Lin WC, Naqvi S, Raszynski A, Totapally BR. Effects of closed endotracheal suctioning on systemic and cerebral oxygenation and hemodynamics in children. Pediatr Crit Care Med 2018; 19 (01) e23-e30
• 8 American Association for Respiratory Care. AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care 2010; 55 (06) 758-764
• 9 Tume LN, Copnell B. Endotracheal suctioning of the critically ill child. J Pediatr Intensive Care 2015; 4 (02) 56-63
• 10 Lema-Zuluaga GL, Fernandez-Laverde M, Correa-Varela AM, Zuleta-Tobón JJ. As-needed endotracheal suctioning protocol vs a routine endotracheal suctioning in pediatric intensive care unit: a randomized controlled trial. Colomb Med (Cali) 2018; 49 (02) 148-153
• 11 Curley MAQ, Harris SK, Fraser KA, Johnson RA, Arnold JH. State behavioral scale: a sedation assessment instrument for infants and young children supported on mechanical ventilation. Pediatr Crit Care Med 2006; 7 (02) 107-114
• 12 Payen JF, Bru O, Bosson JL. et al. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 2001; 29 (12) 2258-2263
• 13 Mittnacht AJ. Near infrared spectroscopy in children at high risk of low perfusion. Curr Opin Anaesthesiol 2010; 23 (03) 342-347
• 14 Booth EA, Dukatz C, Ausman J, Wider M. Cerebral and somatic venous oximetry in adults and infants. Surg Neurol Int 2010; 1: 75
• 15 Maggiore SM. Endotracheal suctioning, ventilator-associated pneumonia, and costs: open or closed issue?. Intensive Care Med 2006; 32 (04) 485-487
• 16 Özden D, Görgülü RS. Development of standard practice guidelines for open and closed system suctioning. J Clin Nurs 2012; 21 (9-10): 1327-1338
• 17 Davies K, Bulsara MK, Ramelet AS, Monterosso L. Audit of endotracheal tube suctioning a pediatric intensive care unit. Clin Nurs Res 2017; 26 (01) 68-81
• 18 Maggiore SM, Iacobone E, Zito G, Conti C, Antonelli M, Proietti R. Closed versus open suctioning techniques. Minerva Anestesiol 2002; 68 (05) 360-364
• 19 Maggiore SM, Lellouche F, Pignataro C. et al. Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice. Respir Care 2013; 58 (10) 1588-1597
• 20 Mosca FA, Colnaghi M, Lattanzio M, Bray M, Pugliese S, Fumagalli M. Closed versus open endotracheal suctioning in preterm infants: effects on cerebral oxygenation and blood volume. Biol Neonate 1997; 72 (01) 9-14
• 21 Skov L, Ryding J, Pryds O, Greisen G. Changes in cerebral oxygenation and cerebral blood volume during endotracheal suctioning in ventilated neonates. Acta Paediatr 1992; 81 (05) 389-393
• 22 Bourgault AM, Brown CA, Hains SM, Parlow JL. Effects of endotracheal tube suctioning on arterial oxygen tension and heart rate variability. Biol Res Nurs 2006; 7 (04) 268-278
• 23 Kohlhauser C, Bernert G, Hermon M, Popow C, Seidl R, Pollak A. Effects of endotracheal suctioning in high-frequency oscillatory and conventionally ventilated low birth weight neonates on cerebral hemodynamics observed by near infrared spectroscopy (NIRS). Pediatr Pulmonol 2000; 29 (04) 270-275
• 24 Jöbsis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science 1977; 198 (4323): 1264-1267
• 25 Chakravarti S, Srivastava S, Mittnacht AJ. Near infrared spectroscopy (NIRS) in children. Semin Cardiothorac Vasc Anesth 2008; 12 (01) 70-79
• 26 Brazy JE, Lewis DV. Changes in cerebral blood volume and cytochrome aa3 during hypertensive peaks in preterm infants. J Pediatr 1986; 108 (06) 983-987
• 27 Scheeren TW, Schober P, Schwarte LA. Monitoring tissue oxygenation by near infrared spectroscopy (NIRS): background and current applications. J Clin Monit Comput 2012; 26 (04) 279-287
• 28 Kurth CD, Steven JM, Nicolson SC. Cerebral oxygenation during pediatric cardiac surgery using deep hypothermic circulatory arrest. Anesthesiology 1995; 82 (01) 74-82