Efficacy of an Automated Secretion Removal Technology at Different Inspiratory Pressures

被引:5
作者
Nielsen, Anne H. [1 ,2 ]
Karbing, Dan S. [3 ]
Solling, Christoffer G. [4 ]
Winding, Robert R. [1 ]
Rees, Stephen E. [3 ,5 ]
Dey, Nilanjan [1 ]
机构
[1] Godstrup Hosp, Dept Anaesthesiol & Intens Care, Herning, Denmark
[2] Aarhus Univ, Dept Clin Med, Aarhus, Denmark
[3] Aalborg Univ, Dept Hlth Sci & Technol, Resp & Crit Care Grp, Gistrup, Denmark
[4] Reg Hosp Viborg, Dept Anaesthesiol & Intens Care, Viborg, Denmark
[5] Aalborg Univ, Dept Hlth Sci & Technol, Selma Lagerloftvej 249, DK-9260 Gistrup, Denmark
关键词
Tracheal secretions; artificial cough; endotracheal suctioning; mechanical ventilation; INTENSIVE-CARE-UNIT; RECOLLECTION; VENTILATION; VALIDATION;
D O I
10.4187/respcare.10850
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND: Endotracheal suctioning is resource demanding, causes patient discomfort, and is associated with adverse effects. A new artificial cough method has been developed for automated secretion removal by using rapid deflation and inflation of the endotracheal tube cuff during the inspiratory phase of mechanical ventilation. This method has been evaluated in a bench model and in animals but not in human subjects. The aim of this study was to investigate whether this method can remove the need for endotracheal suctioning in subjects and whether this is dependent on ventilator settings. METHODS: This prospective, non-controlled study recruited 20 subjects on invasive mechanical ventilation. On the clinical need for endotracheal suctioning, the automatic cough procedure was applied 3 times over 30 s, with this repeated at higher ventilatory pressure and lower respiratory frequency if considered unsuccessful. Success was determined by removal of the clinical need for suctioning. Subject safety and comfort was measured by using the Critical-Care Pain Observation Tool before and after the procedure, and negative effects were recorded. To assess intra-subject variability, the procedure was performed on 3 different occasions for each subject. RESULTS: The procedure was successful in 18 of 20 subjects (90%), with mean subject success rates of 53% at low settings (peak inspiratory pressure 21.8 +/- 3.8 cm H2O) and 83% at high settings (peak inspiratory pressure 25.6 +/- 3.6 cm H2O). The Critical-Care Pain Observation Tool category remained unchanged in 30 procedures (77%), improved in 7 (18%), and deteriorated in 2 (5%). CONCLUSIONS: This study illustrated the potential for significant reduction in the clinical need for endotracheal suctioning after the use of an automated artificial cough procedure at both low and high peak inspiratory pressures, and that was well tolerated.
引用
收藏
页码:1502 / 1509
页数:8
相关论文
共 18 条
[1]   AARC Clinical Practice Guidelines: Artificial Airway Suctioning [J].
Blakeman, Thomas C. ;
Scott, J. Brady ;
Yoder, Mark A. ;
Capellari, Emily ;
Strickland, Shawna L. .
RESPIRATORY CARE, 2022, 67 (02) :258-271
[2]  
Branson RD, 2007, RESP CARE, V52, P1328
[3]   Effects of Mechanical Insufflation-Exsufflation on Airway Mucus Clearance Among Mechanically Ventilated ICU Subjects [J].
Ferreira de Camillis, Marcio Luiz ;
Savi, Augusto ;
Rosa, Regis Goulart ;
Figueiredo, Mariana ;
Wickert, Ricardo ;
Alegretti Borges, Luis Guilherme ;
Galant, Lucas ;
Teixeira, Cassiano .
RESPIRATORY CARE, 2018, 63 (12) :1471-1477
[4]   Validation of the Danish version of the Critical Care Pain Observation Tool [J].
Frandsen, J. B. ;
Poulsen, K. S. O'Reilly ;
Laerkner, E. ;
Stroem, T. .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 2016, 60 (09) :1314-1322
[5]  
Gélinas C, 2006, AM J CRIT CARE, V15, P420
[6]   Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation: a randomized controlled trial [J].
Goncalves, Miguel R. ;
Honrado, Teresa ;
Winck, Joao Carlos ;
Paiva, Jose Artur .
CRITICAL CARE, 2012, 16 (02)
[7]   Patients' recollections of experiences in the intensive care unit may affect their quality of life [J].
Granja, C ;
Lopes, A ;
Moreira, S ;
Dias, C ;
Costa-Pereira, A ;
Carneiro, A .
CRITICAL CARE, 2005, 9 (02) :R96-R109
[8]   Weak Cough Strength and Secretion Retention in Mechanically Ventilated Patients: Is There a Role for Cough-Assist Devices? [J].
Guimaraes, Fernando S. ;
Rocha, Angelo R. M. .
RESPIRATORY CARE, 2018, 63 (12) :1583-1584
[9]   Decreasing the Adverse Effects of Endotracheal Suctioning During Mechanical Ventilation by Changing Practice [J].
Maggiore, Salvatore Maurizio ;
Lellouche, Francois ;
Pignataro, Claudia ;
Girou, Emmanuelle ;
Maitre, Bernard ;
Richard, Jean-Christophe M. ;
Lemaire, Francois ;
Brun-Buisson, Christian ;
Brochard, Laurent .
RESPIRATORY CARE, 2013, 58 (10) :1588-1597
[10]   ???????Effects of Mechanical Insufflation-Exsufflation With Different Pressure Settings on Respiratory Mucus Displacement During Invasive Ventilation br [J].
Marti, Joan-Daniel ;
Martinez-Alejos, Roberto ;
Pilar-Diaz, Xabier ;
Yang, Hua ;
Pagliara, Francesco ;
Battaglini, Denise ;
Meli, Andrea ;
Yang, Milan ;
Bobi, Joaquim ;
Rigol, Monsterrat ;
Tronstad, Oystein ;
Volpe, Marcia Souza ;
Passos Amato, Marcelo Britto ;
Li Bassi, Gianluigi ;
Torres, Antoni .
RESPIRATORY CARE, 2022, 67 (12) :1508-1516