Endotracheal intubation or tracheostomy should be done to assure air way patency in critically ill patients with disturbances in level of consciousness or the central nervous system. But, an endotracheal tube or a tracheostomy tube interferes
with
the
cough reflex and mucociliary action. Patients intubated or having a tracheostomy can not expell secretions from the air way and need endotracheal suction.
Endotracheal suction removes secretions, maintains air way patency, and promotes oxygenation. However, suction is not necessarily a benign procedure and may be associated with a variety of complications including suction-induced hypoxemia,
cardiac
arrhythmias, microatelectasis, tissue damage, infection, bronchospasm, cardiac arrest and even death. Even thogh hyperoxygenation and hyperinflation are done before and after endotracheal suction for prevention of complications, a decrease in
arterial
oxygen tension (PaO2) and cardiac arrhythmias may occur after suctioning.
This study was designed to provide baseline data for further research to develop an efficient endotracheal suction method which would minimize the decrease in PaO2 and occurrence of cardiac arrhythmias.
The specific objectives were to assess the changes in PaO2, and the occurrence of cardiac arrhythmias before, during and after endotracheal suction.
Data were collected from March 5 to May 8, 1993 at a university teaching hospital in Seoul.
Subjects were 15 neurosurgical adult patients with an endotracheal tube or a tracheostomy tube, who were admitted to the Intensive Care Unit or the Cerebral Vascular Accident Center.
Endotracheal suction, based on previous study outcomes, consisted of ambu bagging 3 times with an oxygen supply of 10 L/min before and after the suctioning.
PaO2 was measured by analysis of arterial blood gas before, during and immediately after, then 30 sec, 1 min, 3 min, 5 min, and 10 min, after the endotracheal suctioning.
Cardiac arrhythmias were measured by an electrocardiogram recoreded before, during and after the endotracheal suctioning.
The data were analyzed by using an S. P. S. S. computerized program for mean, standard deviation, percentage and paired t-test.
@ES the results of this study were as follows:
@EN 1. The increase in PaO2 after hyperoxygenation and hyperinflation was highly statistically significant (p=0.041), and the increase in PgO2 immediately after suctioning was not significant (p=0.752). The time of lowest PaO2 was 30 seconds
after
the
endotracheal suction.
2. The occurrence of cardiac arrhythmia after the endotracheal suction included sinus tachycardia, sinus arrhythmia, sinus bradycardia, premature atrial contraction (PAC), and premature ventricular contraction (PVC). The most frequent cardiac
arrhythmia was sinus tachycardia (a subjects).
Sinus arrhythmia was observed in 5 subjects and continues till 10 minutes after suctioning in two of these.
Sinus bradycardia occurred in only 3 subjects and among them, 1 subjects shows sinus arrhythmia till 10 minutes after suctioning along.
PAC was observed in only one subject and continued till five mintues after suctining along with sinus arrhythmia.
PVC was observed in three subjects : It lasted for only 30 seconds after suctioning in two subjects. But continued for 10 minutes after suctioning in the third.
6 subjects manifested two kinds of cardiac arrhythmia. Three of them showed sinus tachycardia with PVC, another 2 showed sinus bradycardia with sinus arrhythmia, and the other subject showed sinus arrhythmia with PAC.
3. The increases in heart rate during the endotracheal suction immediately after and at 30 seconds after suctioning were statistically significant (p=0.005). The increase in hcart rate at one minute after suctioning was also significant
(p=0.023).
4. The increase in heart rate continued until 10 minutes after the endotracheal suction, but was not statistically significant.
In this study, endotracheal suctioning with hyperoxygenation and hyperinflation was effective in preventing a decrease in PaO2 after suctioning, but not in preventing cardiac arrhythmias.
Nurses should be aware of the complications of endotracheal suctioning and do effectve hyperoxygenation and hyperinflation before and after suctioning.
Further research is needed to develop a efficient endotracheal suction method which will minimize complications. This study needs to be replicated with different population of patients intubatted or having a tracheostomy, specifically, patients
who
cardiac or pulmonary desease.
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