Frequent tracheal suctioning is associated with extubation failure in patients with successful spontaneous breathing trial: a single-center retrospective cohort study

Background Extubation failure, i.e., reintubation in ventilated patients, is a well-known risk factor for mortality and prolonged stay in the intensive care unit (ICU). Although sputum volume is a risk factor, the frequency of tracheal suctioning has not been validated as a predictor of reintubation. We conducted this study to examine whether frequent tracheal suctioning is a risk factor for reintubation. Patients and methods We included adult patients who were intubated for > 72 h in the ICU and extubated after completion of spontaneous breathing trial (SBT). We compared the characteristics and weaning-related variables, including the frequency of tracheal suctioning between patients who required reintubation within 24 h after extubation and those who did not, and examined the factors responsible for reintubation. Results Of the 400 patients enrolled, reintubation was required in 51 (12.8%). The most common cause of reintubation was difficulty in sputum excretion (66.7%). There were significant differences in sex, proportion of patients with chronic kidney disease, pneumonia, ICU admission type, the length of mechanical ventilation, and ICU stay between patients requiring reintubation and those who did not. Multivariate analysis showed frequent tracheal suction (> once every 2 h) and the length of mechanical ventilation were independent factors for predicting reintubation. Conclusion We should examine the frequency of tracheal suctioning > once every 2 h in addition to the length of mechanical ventilation before deciding to extubate after completion of SBT in patients intubated for > 72 h in the ICU.

Construction of a detachable artificial trachea model for three age groups for use in an endotracheal suctioning training environment simulator

Tracheal suctioning is an important procedure to maintain airway patency by removing secretions. Today, suctioning operators include not only medical staff, but also family caregivers. The use of a simulation system has been noted to be the most effective way to learn the tracheal suctioning technique for operators. While the size of the trachea varies across different age groups, the artificial trachea model in the simulation system has only one fixed model. Thus, this study aimed to construct multiple removable trachea models according to different age groups. We enrolled 20 patients who had previously received proton beam therapy in our institution and acquired the treatment planning computed tomography (CT) image data. To construct the artificial trachea model for three age groups (children, adolescents and young adults, and adults), we analyzed the three-dimensional coordinates of the entire trachea, tracheal carina, and the end of the main bronchus. We also analyzed the diameter of the trachea and main bronchus. Finally, we evaluated the accuracy of the model by analyzing the difference between the constructed model and actual measurements. The trachea model was 8 cm long for children and 12 cm for adolescents and young adults, and for adults. The angle between the trachea and bed was about 20 degrees, regardless of age. The mean model accuracy was less than 0.4 cm. We constructed detachable artificial trachea models for three age groups for implementation in the endotracheal suctioning training environment simulator (ESTE-SIM) based on the treatment planning CT image. Our constructed artificial trachea models will be able to provide a simulation environment for various age groups in the ESTE-SIM.

A simple, effective enclosure with disposable coverings for inexpensive containment of aerosolized COVID viruses during tracheal intubation and extubation

Structured AbstractBackgroundSARS-CoV-2 (COVID-19) is a severe respiratory virus that can be transmitted through aerosol particles produced by coughing, talking, and breathing. Medical procedures used to treat severe cases such as tracheal intubation, extubation, and tracheal suctioning produce infectious aerosol particles. This presents significant risk for viral exposure of nearby healthcare workers during and following tracheal operations. This study looks at an enclosure to limit medical personnel’s exposure to these particles.MethodsA low-cost plastic enclosure was designed to reduce aerosol spread and viral transmission during intubation and extubation procedures. The enclosure consists of clear polycarbonate for maximum visibility. Large side cutouts provide health care providers with ease of access to the patient. Aerosol particle instruments measured the aerosol containment efficacy after applying various types of plastic coverings to seal the side openings. The use of negative pressure was also tested.ResultsThe enclosure with 2 layers of plastic coverings sealing the side openings reduced total escaped particle number concentrations (diameter > 0.01 μm) by over 93% at 3 inches away from all openings. Concentration decay experiments indicated that the enclosure without active suction should be left on the patient for 15-20 minutes following a tracheal manipulation to allow sufficient time for >90% of aerosol particles to settle upon interior surfaces. This decreases to 5 minutes when 30 LPM suction is applied.ConclusionsThis enclosure is an inexpensive, easily implemented additional layer of protection that can be used to reduce the risk of SARS-CoV-2 aerosol transmission between patients and healthcare workers.

Closed tracheal suctioning systems in the era of COVID-19: is it time to consider them as a gold standard?

Tracheal suctioning is one of the most common activities performed in intensive care units (ICU) and is recognised as a high-risk procedure by the World Health Organization (WHO) and Centers for Disease Control (CDC). Aerosol-generating procedures on critical patients with COVID-19 present an increased risk of contamination for medical workers. In the time of the Sars-Cov-2 pandemic, with a massive number of patients with COVID-19 admitted to the ICU, the open tracheal suction technique (OTST) represents a serious threat for medical workers, even if they are wearing full personal protective equipment. Closed tracheal suction systems (CTSS) allow the removal of tracheobronchial secretions without disconnecting ventilatory circuits, preventing alveolar derecruitment, gas exchange deterioration and hypoxia. CTSS reduce the risk of pathogens entering the respiratory circuit and appear to be a cost-effective solution. CTSS should be considered mandatory for patients in the ICU with an artificial airway, in order to reduce bioaerosol exposure risk for medical workers and contamination of the surrounding environment.

Bronchoscopic Intervention May be Associated with Better Outcomes in Mechanically Ventilated Coronavirus Disease-19 Patients: A Case Series

BACKGROUND: The emergence of a new strain of coronavirus infection, the coronavirus infection disease 2019 (COVID-19), has been a pandemic burden across the globe. Severe COVID-19, particularly in patients with acute respiratory distress syndrome (ARDS), is associated with increased risk of admission to intensive care unit (ICU), mechanical ventilation, and mortality. Bronchoscopy has been widely employed as an adjunctive therapy in mechanically ventilated patients. However, the use of bronchoscopy in patients with COVID-19 has been strictly limited due to aerosol transmission. CASE REPORT: We reported 3 COVID-19 Cases presented to the hospital with ARDS. All of the patients were immediately intubated to improve oxygenation. During admission, the patients produced immense airway secretions that might have resulted in partial airway obstruction. A conventional tracheal suctioning did not help to promote clinical improvement. We decided to perform bronchoscopy with controlled suctioning by following a very tight protocol to prevent aerosol formation. A significant clinical and respiratory improvement was observed in all patients following bronchoscopy. Three of them were transferred to regular ward, however, one patient died during hospitalization. CONCLUSION: Bronchoscopic procedures may provide significant therapeutic benefits in severe COVID-19 patients. However, it should be kept in mind that this procedure should only be performed with a rigorous protocol to reduce the risk of aerosol generation and subsequent viral transmission.