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Endotracheal suctioning: from principles to practice

  • Neonatal And Pediatric Intensive Care
  • Published:
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Abstract

Objective

This paper aims to highlight the physical principles of pressure and flow dynamics underlying endotracheal suctioning, to demonstrate these on a simple illustrative model and to discuss the clinical implications of these principles for paediatric practice.

Design

Prospective in vitro study.

Setting

Paediatric intensive care unit of a tertiary, academic hospital.

Measurements and main results

The peak pressure change (ΔP) obtained in a “bag-in-box” model was recorded during suctioning, using different combinations of endotracheal tube (ETT) and catheter sizes, different suction pressures and techniques. Suction was also performed on three different consistencies of gelatine, using a range of suction catheter sizes and vacuum pressures. The mass of gelatine suctioned per second was calculated. A large ΔP was measured when using neonatal-sized ETTs. There was a linear relationship (r=0,8, p<0.05) between ΔP and the ratio of external catheter area to area difference (internal ETT area−external catheter area). Significantly greater ΔP was measured when using a short versus long suction catheter (p<0.001) and when applying suction for longer duration (p<0,001) and with higher vacuum pressures (p<0.05). The amount of mucus suctioned in a given time was related to catheter size, suction pressure and mucus density.

Conclusion

Applied clinically, these results indicate that intrapulmonary pressure changes generated by the endotracheal suctioning of intubated neonates are likely to be considerable, possibly translating into loss of lung volume.

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Acknowledgements

We thank Lance Howell for technical support.

Author information

Authors and Affiliations

  1. Physiotherapy Department and Paediatric Intensive Care Unit, Red Cross War Memorial Children’s Hospital, School of Health and Rehabilitation Sciences and School of Child and Adolescent Health, University of Cape Town , Klipfontein Road, 7700, Rondebosch, Cape Town, South Africa

    Brenda M. Morrow

  2. Department of Physiotherapy, School of Health and Rehabilitation Sciences, University of Cape Town, Observatory, Private Bag, 7935, Cape Town, South Africa

    Merle J. Futter

  3. Paediatric Intensive Care Unit, School of Child and Adolescent Health, Red Cross War Memorial Children’s Hospital, Klipfontein Road, 7700, Rondebosch, Cape Town, South Africa

    Andrew C. Argent

Authors
  1. Brenda M. Morrow
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  2. Merle J. Futter
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  3. Andrew C. Argent
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Corresponding author

Correspondence to Brenda M. Morrow.

Additional information

This work was supported by research grants from Institute of Child Health (University of Cape Town) and South African Physiotherapy Research Foundation. Consumables were funded by EMS – VEN Medical (RSA).

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Morrow, B.M., Futter, M.J. & Argent, A.C. Endotracheal suctioning: from principles to practice. Intensive Care Med 30, 1167–1174 (2004). https://doi.org/10.1007/s00134-004-2238-0

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  • DOI: https://doi.org/10.1007/s00134-004-2238-0

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