A quantitative evaluation of aerosol generation from upper airway suctioning during tracheal intubation and extubation sequences.

Background: Open respiratory suctioning is considered to be an aerosol generating procedure (AGP) and laryngopharyngeal suction, used to clear secretions during anaesthesia, is widely managed as an AGP. It is uncertain whether such upper airway suctioning should be designated an aerosol generating procedure (AGP) because of a lack of both aerosol and epidemiological evidence of risk. Aim: To assess the relative risk of aerosol generation by upper airway suction during tracheal intubation and extubation in anaesthetised patients. Methods: Prospective environmental monitoring study in ultraclean operating theatres to assay aerosol concentration during intubation and extubation sequences including upper airway suctioning for patients undergoing surgery (n=19 patients). An Optical Particle Sizer (particle size 300nm-10μm) was used to sample aerosol 20cm above the mouth of the patient. Baseline recordings (background, tidal breathing and volitional coughs) were followed by intravenous induction of anaesthesia with neuromuscular blockade. Four periods of oropharyngeal suction were performed with a Yankauer sucker: pre-laryngoscopy, post-intubation and pre- and post-extubation. Findings: Aerosol from breathing was reliably detected (65[39-259] particles.L-1 (median[IQR])) above background (4.8[1-7] particles.L-1, p<0.0001 Friedman). The procedure of upper airway suction was associated with much lower average concentrations of aerosol than breathing (6.0[0-12] particles.L-1, P=0.0007) and was indistinguishable from background (P>0.99). The peak aerosol concentration recorded during suctioning (45[30-75] particles.L-1) was much lower than both volitional coughs (1520[600-4363] particles.L-1, p<0.0001, Friedman) and tidal breathing (540[300-1826] particles.L-1, p<0.0001, Friedman). Conclusion: The procedure of upper airway suction during airway management is associated with no higher concentration of aerosol than background and much lower than breathing and coughing. Upper airway suction should not be designated as a high risk AGP.

Comparison of three interventional approaches to prevent ventilator-associated pneumonia in intensive care units (ICUs): A clinical trial study

Background: Ventilator-associated pneumonia (VAP) is an infectious pulmonary disease that develops after 48 hours of ventilation. To date, several methods have been proposed to reduce VAP occurrence, such as the VAP prevention bundle, which involves raising the head of the bed, reducing sedation, avoiding deep vein thrombosis, and preventing peptic ulcer in the gastrointestinal system. The purpose of this study was to evaluate the role of personnel in hand washing, case airway suctioning, and systematic monitoring in the prevention of VAP. Methods: In the current clinical trial, 129 patients hospitalized and intubated at Vali-e-Asr Hospital ICU in Arak, Iran, were included in the study and randomized to one of the three VAP prevention methods: group A, VAP prevention bundle measures; group B, group A measures plus washing of patients’ mouth with 0.12% chlorhexidine and suction of secretion every six hours; and finally group C, group B measures plus 72-hour suction package. Demographic information, VAP diagnosis, and outcome of each patient were recorded in the special checklist. Results: The age of the patients ranged from 18 years to 93 years with a mean of 54.6 ± 21.8 years. There was no significant difference in age, sex, Clinical Pulmonary Infection Score (CPIS), and Glasgow Coma Scale (GCS) between the three groups. However, there is a significant relationship between chest X-ray (CXR) index and pneumonia in the three groups (p < 0.05). The prevalence of pneumonia is generally seen to be higher in patients who were local, diffuse, or patchy than those who had no infiltration (p < 0.05). Conclusion: This study showed that the application of VAP prevention bundle measures, mouthwash with chlorhexidine, personnel hand washing, airway suctioning, and systematic monitoring is an efficient approach to the prevention of VAP in ICUs.

NURSES’ KNOWLEDGE AND ATTITUDE ON PRACTICE OF ARTIFICIAL AIRWAY SUCTIONING

ABSTRACT: Artificial airway suctioning is one of the key nursing skills that nurses should acquire during student period and maintains during their professional life. The current study is mainly intended to assess the knowledge and attitude among graduate nurses, Kerala. A quantitative descriptive approach was used as methodology with convenient sampling technique and data were collected using electronic forms. Data were analyzed using descriptive and inferential statistics. There is a mild correlation between knowledge and attitude score (r=0.199) and significant association can be traced with the area of experience and knowledge (chi-square=0.037) and the training undergone related to suctioning and attitude on practice related to suctioning (chi-square=0.000674). Key words: Knowledge, Attitude, Artificial airway suctioning, Graduate Nurses.

Pengaruh Suction Terhadap Kadar Saturasi Oksigen Pada Pasien Koma Di Ruang ICU RSUD Dr. Moewardi Surakarta Tahun 2015

: Saturation Of Oxygen, Suction, Coma Patients. Decreas consciousness and coma is very deep response. Comatose patients often experience problems mainly due to accumulation of secretions that coma patients decreased cough reflex. So that the patient needs to be done to free the airway suctioning of secretions. A phenomenon that occurs in the ICU Hospital Dr. Moewardi almost comatose patients conducted periodically suction approximately every 2 hours.The purpose of this study was to determine the effect of suction on oxygen saturation in patients with coma in the ICU Hospital Dr. Moewardi Surakarta 2015. This type of research is quasy experimental research design is a one-group pretest-posttest design and analysis using paired samples T-test.Based on the results of the Shapiro-Wilk normality test can be concluded that the data tedistribusi normal. So using a paired samples T test with significance value (p) was 0.000, which is the value of p <0.05. This means that there is an average difference of oxygen saturation value before the suction action after the suction action. Oxygen saturation difference is -1.79, meaning that oxygen saturation values prior to suction smaller than the value of the oxygen saturation after the suction.