A Comparison of Two Methods of Preoxygenation during Endotracheal Suctioning

Abstract

A new single-lumen oxygen-insufflation catheter designed to alternately deliver oxygen or suction was evaluated to determine whether its use could prevent episodes of hypoxemia during endotracheal suctioning. METHODS & MATERIALS: Insufflation-catheter suctioning was compared to resuscitation-bag suctioning in 23 adult patients (FIO2 0.30 to 0.50) from the medical, surgical, and neurological ICUs. Patients were selected for the study if we were able to obtain informed consent and if they were intubated with a ≥ 7.5-mm-ID endotracheal tube or tracheostomy tube, had an arterial cannula, and were on < 10 cm H2O PEEP. All suctioning episodes consisted of two suction passes with 10 seconds of continuous suction at -120 torr. For the conventional method, a resuscitation bag was used to deliver 5 breaths of 100% O2 (before and after the 2 10-second suctioning passes). For the insufflation method, O2 was delivered at 15 L/min through the catheter for 15 seconds prior to the first suctioning, the patient was reconnected to the ventilator for 30 seconds after suctioning, and the procedure was repeated. Each subject served as his/her own control and was randomly assigned to the method used first. The PaO2 and SaO2 were recorded for each method prior to suctioning and at 30, 60, and 180 seconds following the procedure. RESULTS: ANOVA for repeated measures revealed a significant interaction between preoxygenation method and time for both PaO2 and SaO2 (p < 0.001). Oxygen insufflation prevented a clinically important change from baseline in mean PaO2 and SaO2 at all sampling times, while manual ventilation increased mean PaO2 and SaO2. CONCLUSION: This study suggests that adequate arterial oxygenation can be maintained during suctioning using a single-lumen oxygen-insufflation catheter in patients who meet the above criteria.