Optimizing effects on airway pressure and minute volume during closed endotracheal suctioning: a simulated lung model

A closed suction system is used to remove endotracheal secretions without interrupting the patient’s ventilation. Closed suctioning may reduce adverse effects associated with suctioning with, for example, decreased clinical signs of hypoxemia and limited environmental, personnel, and patient contamination. However, it is not clear whether ventilation is maintained during the procedure. We aimed to determine the effects of endotracheal tube (ETT) size, suction catheter (SC) size, and SC length in the ETT on ventilation parameters measured during suction. Suction was performed on a test lung, ventilated with either volume-controlled continuous mandatory ventilation (VC-CMV) or pressure-controlled continuous mandatory ventilation (PC-CMV) using ETT sizes of 6.0–8.5 mm paired with SC sizes of 8–16 French gauge (Fr = 0.33 mm). Airway resistance ( Raw), peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), and expiratory minute volume ( Vexp) were recorded for each ventilation episode by a HAMILTON-G5 ventilator. Here, Raw was considerably increased by insertion of the SC into the ETT. This Raw effect altered the PIP and Vexp. PIP was increased in VC-CMV because the ventilation area of the ETT was reduced, and Vexp was decreased in PC-CMV in relation to the size of the SC. PEEP decreased with application of the 16 Fr SC and 30 L/min flow rate in VC-CMV. We conclude that airway pressure and minute volume are not maintained during closed endotracheal suctioning with VC-CMV and PC-CMV, respectively. The degree of interference to ventilation is affected through selection of appropriate SC size and ventilation settings.

Download Full-text

Closed Endotracheal Suctioning Impact on Ventilator-Related Parameters in Obstructive and Restrictive Respiratory Systems: A Bench Study

Applied Sciences ◽

10.3390/app11115266 ◽

2021 ◽

Vol 11 (11) ◽

pp. 5266

Author(s):

Fang Jung ◽

Shang-Shing P. Chou ◽

Shih-Hsing Yang ◽

Jau-Chen Lin ◽

Guey-Mei Jow

Keyword(s):

Endotracheal Tube ◽

Peak Inspiratory Pressure ◽

Lung Compliance ◽

Minute Volume ◽

Lung Mechanics ◽

Suction Catheter ◽

Pulmonary Mechanics ◽

Outer Diameter ◽

Endotracheal Suctioning ◽

Pulmonary Mechanic

A closed suctioning system (CSS) in patients with coronavirus disease 2019 (COVID-19) prevents spraying respiratory secretions into the environment during suction. However, it is not clear whether ventilation is maintained during the suction procedure, especially in patients with compromised pulmonary mechanics. This paper determines the effects of endotracheal tube (ETT) size, suction catheter size, and two lung mechanics (resistance and compliance) on ventilator-related parameters measured during suction. Suction was performed on an adult training lung, ventilated with either volume-controlled (VC-CMV) or pressure-controlled mandatory ventilation (PC-CMV), using ETT sizes of 6.5–8.0 mm paired with suction catheter sizes of 8–14 French (Fr). Peak inspiratory pressure (PIP) increased by 50% when the ETT’s ventilation area was less than 25 mm2 in size, especially in patients with high airway resistance ventilated with VC-CMV. Positive end-expiratory pressure (PEEP) levels significantly decreased when using 14 Fr SC during VC-CMV and fewer effects during PC-CMV. Change of expiratory minute volume increased with higher outer diameter of suction catheters and decreased with severe lung compliance during PC-CMV. The change in ventilator-related parameters were intently monitored in the patient whose pulmonary mechanic was compromised through the CSS endotracheal tube suctioning procedures in clinical airway management.

Download Full-text

Can you calculate the total respiratory, lung, and chest wall respiratory mechanics?

Journal of Mechanical Ventilation ◽

10.53097/jmv.10007 ◽

2020 ◽

Vol 1 (1) ◽

pp. 24-26

Author(s):

Mia Shokry ◽

Kimiyo Yamasaki ◽

Ehab Daoud

Keyword(s):

Mechanical Ventilation ◽

Tidal Volume ◽

Chest Wall ◽

Airway Pressure ◽

Respiratory Mechanics ◽

Peak Inspiratory Pressure ◽

Esophageal Pressure ◽

Horizontal Line ◽

Pulmonary Pressure ◽

Volume Controlled

Figure: Waveforms for a patient undergoing mechanical ventilation with volume controlled mode. Tidal Volume of 500 ml, PEEP 15, Constant inspiratory flow of 45 l/min A: Airway pressure in cmH2O, B: Esophageal pressure in cmH2O, C: Trans-pulmonary pressure in cmH2O, D: Flow in l/min, E: Tidal volume in ml Red dashed horizontal line: values at end of expiratory occlusion maneuver, White solid horizontal line: values at end of inspiratory occlusion maneuver, Green dashed horizontal line: values during peak inspiratory pressure.

Download Full-text

Using Conventional Infant Ventilators at Unconventional Rates

PEDIATRICS ◽

10.1542/peds.74.4.487 ◽

1984 ◽

Vol 74 (4) ◽

pp. 487-492 ◽

Cited By ~ 1

Author(s):

Stephen J. Boros ◽

Dennis R. Bing ◽

Mark C. Mammel ◽

Erik Hagen ◽

Margaret J. Gordon

Keyword(s):

Tidal Volume ◽

Airway Pressure ◽

Important Determinant ◽

Peak Inspiratory Pressure ◽

Lung Compliance ◽

Minute Volume ◽

Inspiratory Pressure ◽

Positive End Expiratory Pressure ◽

Inspiratory Time ◽

Pressure Monitor

The effect of progressive increases in ventilator rate on delivered tidal and minute volumes, and the effect of changing peak inspiratory pressure (Pmax), positive end-expiratory pressure (PEEP), and inspiration to expiration (I:E) ratio at different ventilator rates were examined. Five different continuous-flow, time-cycled, pressure-preset infant ventilators were studied using a pneumotachograph, an airway pressure monitor, and a lung simulator. As rates increased from 10 to 150 breaths per minute, tidal volume stayed constant until 25 to 30 breaths per minute; then progessively decreased. In all, tidal volume began to decrease when proximal airway pressure waves lost inspiratory pressure plateaus. As rates increased, minute volume increased until 75 breaths per minute, then leveled off, then decreased. Substituting helium for O2 increased the ventilator rate at which this minute volume plateau effect occurred. Increasing peak inspiratory pressure consistently increased tidal volume. Increasing positive end-expiratory pressure decreased tidal volume. At rates less than 75 breaths per minute, inspiratory time (inspiration to expiration ratio) had little effect on delivered volume. At rates greater than 75 breaths per minute, inspiratory time became an important determinant of minute volume. For any given combination of lung compliance and airway resistance: (1) there is a maximum ventilator rate beyond which tidal volume progressively decreases and another maximum ventilator rate beyond which minute volume progressively decreases; (2) at slower rates, delivered volumes are determined primarily by changes in proximal airway pressures; (3) at very rapid rates, inspiratory time becomes a key determinant of delivered volume.

Download Full-text

Adaptive Support Ventilation

Anesthesiology ◽

10.1097/aln.0b013e3181b55f8f ◽

2009 ◽

Vol 111 (4) ◽

pp. 863-870 ◽

Cited By ~ 15

Author(s):

Demet Sulemanji ◽

Andrew Marchese ◽

Paul Garbarini ◽

Marc Wysocki ◽

Robert M. Kacmarek

Keyword(s):

Tidal Volume ◽

Airway Pressure ◽

Minute Volume ◽

Lung Model ◽

Lung Mechanics ◽

Adaptive Support Ventilation ◽

Support Ventilation ◽

Group I ◽

Adaptive Support ◽

Group Ii

Background Adaptive support ventilation (ASV) allows the clinician to set a maximum plateau pressure (PP) and automatically adjusts tidal volume to keep PP below the set maximum. Methods ASV was compared to a fixed tidal volume of 6 ml/kg. ASV determined the respiratory rate and tidal volume based on its algorithms. Maximum airway pressure limit was 28 cm H2O in ASV. Six sets of lung mechanics were simulated for two ideal body weights: 60 kg, Group I; 80 kg, Group II. Positive end expiratory pressure was 8, 12, and 16 cm H2O, and target minute volume 120%, 150%, and 200% of predicted minute volume. Results ASV "sacrificed" tidal volume and minute ventilation to maintain PP in 9 (17%) of 54 scenarios in Group I and 20 (37%) of 54 scenarios in Group II. In Group I, the number of scenarios with PP of 28 cm H2O or more was 14 for ASV (26%) and 19 for 6 ml/kg (35%). In these scenarios, mean PP were ASV 28.8 +/- 0.86 cm H2O (min 28, max 30.3) and 6 ml/kg 33.01 +/- 3.48 cm H2O (min 28, max 37.8) (P = 0.000). In group II, the number of scenarios PP of 28 cm H2O or more was 10 for ASV (19%) and 21 for 6 ml/kg (39%). In these cases, mean PP values were ASV 28.78 +/- 0.54 cm H2O (min 28, max 29.6) and 6 ml/kg 32.66 +/- 3.37 cm H2O (min 28.2, max 38.2) (P = 0.000). Conclusion In a lung model with varying mechanics, ASV is better able to prevent the potential damaging effects of excessive PP (greater than 28 cm H2O) than a fixed tidal volume of 6 ml/kg by automatically adjusting airway pressure, resulting in a decreased tidal volume.

Download Full-text

HIGH FREQUENCY PERCUSSIVE VENTILATION CAN MIMIC AIRWAY PRESSURE RELEASE VENTILATION IN A TEST LUNG MODEL

Critical Care Medicine ◽

10.1097/00003246-200412001-00144 ◽

2004 ◽

Vol 32 (Supplement) ◽

pp. A38

Author(s):

Faera L Byerly ◽

Bruce A Cairns ◽

Kathy A Short ◽

John A Haithcock ◽

Lynn Shapiro ◽

...

Keyword(s):

High Frequency ◽

Airway Pressure ◽

Airway Pressure Release Ventilation ◽

Lung Model ◽

Test Lung ◽

Pressure Release ◽

Pressure Release Ventilation

Download Full-text

Simple point of care continuous positive airway pressure delivery device (Jain-CPAP)

BMJ Innovations ◽

10.1136/bmjinnov-2018-000339 ◽

2019 ◽

Vol 5 (1) ◽

pp. 13-19

Author(s):

Ashish Jain ◽

Robert M DiBlasi ◽

Veena Devgan ◽

Nisha Kumari ◽

Kunal Kalra

Keyword(s):

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Preterm Neonate ◽

Positive Airway Pressure ◽

Point Of Care ◽

Healthcare Providers ◽

Linear Increase ◽

Lung Model ◽

Lung Mechanics ◽

Mean Pressure

ObjectiveTo describe the effective pressure and FiO2 delivery to a realistic spontaneously breathing lung model using a novel, simple, inexpensive neonatal non-invasive bubble continuous positive airway pressure (CPAP) device.MethodsThis experimental bench study was conducted at Bench Testing Laboratory at a Children’s Hospital. A realistic 3D anatomic airway model of a 28-week preterm neonate was affixed to the ASL5000 Test Lung to simulate spontaneous breathing with lung mechanics that are specific to a preterm neonate. The assembly was constructed on site using easily available nasal prongs, paediatric infusion set with a graduated chamber, three-way stop cocks and oxygen tubing. The adult nasal prong was used as cannulae. However, this assembly had the limitation of the lack of humidification and inability to deliver graduated oxygen. This assembly was attached to the anatomic airway with nasal prongs. Pressure and FiO2 were measured from within the lung model at different flow settings and recorded for 10 breaths.ResultsThere was a linear increase in the mean pressure in the 10 recorded breaths as oxygen flows were increased.ConclusionsOur nasal CPAP is a simple device, as it can be easily assembled at the point of care using simple, affordable supplies by the healthcare providers and can benefit the newborns with respiratory distress in the resource constraint settings.

Download Full-text

Identification of Associations between Clinical Signs and Hosts to Monitor the Web for Detection of Animal Disease Outbreaks

Public Health and Welfare ◽

10.4018/978-1-5225-1674-3.ch026 ◽

2016 ◽

pp. 565-586

Author(s):

Elena Arsevska ◽

Mathieu Roche ◽

Pascal Hendrikx ◽

David Chavernac ◽

Sylvain Falala ◽

...

Keyword(s):

Early Detection ◽

Web Mining ◽

Clinical Signs ◽

Disease Outbreaks ◽

Expert Elicitation ◽

Comprehensive Method ◽

Statistical Measures ◽

Animal Pathogens ◽

The Web ◽

Selection Of

In a context of intensification of international trade and travels, the transboundary spread of emerging human or animal pathogens represents a growing concern. One of the missions of the national veterinary services is to implement international epidemiological intelligence for a timely and accurate detection of emerging animal infectious diseases (EAID) worldwide, and take early actions to prevent their introduction on the national territory. For this purpose, an efficient use of the information published on the web is essential. The authors present a comprehensive method for identification of relevant associations between terms describing clinical signs and hosts to build queries to monitor the web for early detection of EAID. Using text and web mining approaches, they present statistical measures for automatic selection of relevant associations between terms. In addition, expert elicitation is used to highlight the most relevant terms and associations among those automatically selected. The authors assessed the performance of the combination of the automatic approach and expert elicitation to monitor the web for a list of selected animal pathogens.

Download Full-text

Endotracheal saline and suction catheters: sources of lower airway contamination

American Journal of Critical Care ◽

10.4037/ajcc1994.3.6.444 ◽

1994 ◽

Vol 3 (6) ◽

pp. 444-447 ◽

Cited By ~ 57

Author(s):

DA Hagler ◽

GA Traver

Keyword(s):

Critical Care ◽

Normal Saline ◽

Catheter Insertion ◽

Lower Airway ◽

Suction Catheter ◽

Endotracheal Suctioning ◽

Saline Irrigation ◽

Endotracheal Tubes ◽

Viable Bacteria ◽

Saline Instillation

BACKGROUND. Normal saline instillation prior to endotracheal suctioning is a critical care ritual that persists despite a lack of demonstrated benefit. Saline instillation may dislodge viable bacteria from a colonized endotracheal tube into the lower airway, overwhelming the defense mechanism of immunocompromised patients. OBJECTIVE. To determine the extent to which normal saline irrigation and suction catheter insertion dislodge viable bacteria from endotracheal tubes. METHODS. Endotracheal tubes from 10 critical care patients intubated for at least 48 hours were obtained immediately after extubation. Each tube was used in random order for both saline instillation and suction catheter insertion. Dislodged material was cultured for quantitative analysis. RESULTS. Suction catheter insertion dislodged up to 60,000 viable bacterial colonies. A 5-mL saline instillation dislodged up to 310,000 viable bacterial colonies. CONCLUSIONS. The potential for infection caused by dislodging bacteria into the lower airway is additional evidence that routine use of saline during suctioning procedures should be abandoned.

Download Full-text

Endotracheal suctioning: ventilator vs manual delivery of hyperoxygenation breaths

American Journal of Critical Care ◽

10.4037/ajcc1996.5.3.192 ◽

1996 ◽

Vol 5 (3) ◽

pp. 192-197 ◽

Cited By ~ 5

Author(s):

MJ Grap ◽

C Glass ◽

M Corley ◽

T Parks

Keyword(s):

Clinical Practice ◽

Lung Injury ◽

Arterial Pressure ◽

Oxygen Saturation ◽

Arterial Oxygen ◽

Suction Catheter ◽

Endotracheal Suctioning ◽

Arterial Blood ◽

Before And After ◽

The Impact

BACKGROUND: Despite a large number of studies on endotracheal suctioning, there is little data on the impact of clinically practical hyperoxygenation techniques on physiologic parameters in critically ill patients. OBJECTIVE: To compare the manual and mechanical delivery of hyperoxygenation before and after endotracheal suctioning using methods commonly employed in clinical practice. METHODS: A quasi-experimental design was used, with twenty-nine ventilated patients with a lung injury index of 1.54 (mild-moderate lung injury). Three breaths were given before and after each of two suction catheter passes using both the manual resuscitation bag and the ventilator. Arterial pressure, capillary oxygen saturation, heart rate, and cardiac rhythm were monitored for 1 minute prior to the intervention to obtain a baseline, continuously throughout the procedure, and for 3 minutes afterward. Arterial blood gases were collected immediately prior to the suctioning intervention, immediately after, and at 30, 60, 120, and 180 seconds after the intervention. Data were analyzed with repeated measures analysis of variance. RESULTS: Arterial oxygen partial pressures were significantly higher using the ventilator method. Peak inspiratory pressures during hyperoxygenation were significantly higher with the manual resuscitation bag method. Significant increases were observed in mean arterial pressure during and after suctioning, with both delivery methods, with no difference between methods. Maximal increases in arterial oxygen partial pressure and arterial oxygen saturation occurred 30 seconds after hyperoxygenation, falling to baseline values at 3 minutes for both methods. CONCLUSION: Using techniques currently employed in clinical practice, these findings support the use of the patient's ventilator for hyperoxygenation during suctioning.

Download Full-text

An Interactive Endotracheal Suctioning Simulator Which Exhibits Vital Reactions: ESTE-SIM

International Journal of Automation Technology ◽

10.20965/ijat.2019.p0490 ◽

2019 ◽

Vol 13 (4) ◽

pp. 490-498 ◽

Cited By ~ 1

Author(s):

Shunsuke Komizunai ◽

Shinji Ninomiya ◽

Atsushi Konno ◽

Satoshi Kanai ◽

Tadayoshi Asaka ◽

...

Keyword(s):

Nursing Education ◽

Health Care Professionals ◽

Measurement Data ◽

Suction Catheter ◽

Measurement Information ◽

Care Providers ◽

Endotracheal Suctioning ◽

Training Environment ◽

Actual Measurement ◽

Vital Reactions

This paper describes a next-generation nursing education simulator, the endotracheal suctioning training environment simulator (ESTE-SIM), which is capable of interactively reproducing vital reactions. With the spread of home treatment, care providers who have received a certain level of nursing education should be increased, not limited to conventional health-care professionals. A great gap exists between simulations under restricted conditions that have been practiced in conventional nursing education and those in the actual clinical site, thus creating a burden on nurses and patients. If a simulator that approaches real clinical situations can be developed, it will not only contribute to lessening the burden on nurses but also improve the quality of nursing care. The ESTE-SIM, which simulates endotracheal suctioning, can measure the movements of the suction catheter inserted in the trachea. The measurement information is used to estimate the progress of the nursing maneuver, which is then used to reproduce vital reactions, including dynamic facial expression changes based on projection mapping and monitor-displayed vital signs. To design and control the vital reactions, a mathematical model to determine the behavior of the simulator is formulated based on the actual measurement data of the vital reactions of patients and the experiential knowledge of nurses. By integrating these element technologies, we developed a novel interactive nursing education simulator capable of recreating typical vital reactions that occur during the basic endotracheal suctioning maneuver.

Download Full-text