The Efficacy of Oxygen Insufflation in Preventing Arterial Oxygen Desaturation during Endotracheal Suctioning of Mechanically Ventilated Patients

Abstract

The fact that endotracheal suctioning (ETS) of mechanically ventilated patients can cause hypoxemia has sometimes been addressed by preoxygenating the patient, often by raising the FIO2 supplied by the ventilator. However, this presents the risk that the FIO2 may inadvertently be left high after ETS, with potentially undesirable effects. We investigated an alternate technique that does not include preoxygenation: use of the Jinotti double-lumen suction/oxygen catheter that permits oxygen insufflation of the lung, alternating with periods of suction. We compared this technique with a preoxygenation technique to test the hypothesis that the oxygen insufflation method would prevent arterial oxygen desaturation during and after endotracheal suctioning. Methods: In each of 18 critically ill mechanically ventilated patients receiving 50% or less oxygen, we employed two suctioning techniques, which were applied in random order. One technique used a standard suction catheter and the patient was preoxygenated via the ventilator (MA-1 or 900C). The other technique used the Jinotti double-lumen suction/oxygen catheter and no preoxygenation. The Jinotti catheter and its associated valve will deliver suction or oxygen insufflation as the operator selects; when suction is being used, oxygen does not flow, and vice versa. Each patient was suctioned twice by each technique, and SaO₂ was continuously monitored by a pulse oximeter and a recorder. Results: With the preoxygenation technique, the mean baseline SaO₂ was 99 ± 1.1% (mean ± SD), and the mean maximum desaturation was 1.0 ± 1.4%. With the oxygen insufflation technique, the mean baseline SaO₂ was 96 ± 2.5%, and the mean maximum desaturation was 2.0 ± 2.1%. In a comparison of maximum desaturation values to baseline values for SaO₂, there was no statistically significant difference between the results of using the two suctioning techniques. Conclusions: We feel that in mechanically ventilated patients receiving 50% or less oxygen, use of the oxygen insufflation catheter can prevent hypoxemia during endotracheal suctioning. The use of this technique can also save the time that preoxygenation would take, and it eliminates the risk that ventilator-supplied oxygen will be left at high levels after suctioning.