Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2001;2001(3):CD000427.
doi: 10.1002/14651858.CD000427.

Preoxygenation for tracheal suctioning in intubated, ventilated newborn infants

M Pritchard  1 , V Flenady, P Woodgate
Affiliations

Preoxygenation for tracheal suctioning in intubated, ventilated newborn infants

M Pritchard et al. Cochrane Database Syst Rev. 2001.

Abstract

Background: Endotracheal suctioning for mechanically ventilated infants is routine practice in neonatal intensive care. However, this practice is associated with serious complications including lobar collapse, pneumothorax, bradycardia and hypoxemia. Increasing the inspired oxygen immediately prior to suction (preoxygenation) has been proposed as an intervention to minimise the risk of complications.

Objectives: To compare the effects of preoxygenation with no preoxygenation for endotracheal suctioning on ventilated newborn infants. To conduct sub group analyses by i) different populations of newborn infants; by gestational age <30 weeks, <34 weeks and <37 weeks and by disease; infants with chronic lung disease compared to those without and; ii) by different techniques of endotracheal suctioning; with or without disconnection from the ventilator, increased mechanical ventilation, use of manual ventilation and chest wall vibrations or percussion.

Search strategy: The standard search strategy of the Neonatal Review Group was used. This included searches of electronic databases; Oxford Database of Perinatal Trials; Cochrane Controlled Trials Register (Cochrane Library Issue 1 2001); MEDLINE (1966 - April 2001); and CINAHL (1982-2001) using MeSH term infant-newborn and text terms oxygen* and suction*, preoxygenation, pre-oxygenation and premature and also previous reviews including cross references, abstracts in conferences and symposia proceedings, expert informants, journal hand searching in the English language.

Selection criteria: Random or quasi random controlled trials of mechanically ventilated neonates in which endotracheal suctioning with preoxygenation was compared to suctioning without preoxygenation.

Data collection and analysis: Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used, including independent assessment of trial quality and extraction of data by the authors. Data were analysed using relative risk (RR) for dichotomous outcomes and mean difference (MD) for data measured on a continuous scale with the use of 95% confidence intervals. Meta-analysis was conducted using a fixed effects model.

Main results: One cross-over trial involving outcomes for 16 preterm neonates was included in this review. Preoxygenation, prior to an endotracheal suctioning procedure involving two suctions, resulted in a statistically significant reduction in infants with hypoxemia (TcPO2 <40 mmHg) at the end of the first suction (RR 0.18, 95% CI 0.05, 0.69), at the end of the second suction (RR 0.23, 95% CI 0.08, 0.66) and also at 120 seconds after the second suction (RR 0.10, 95% CI 0.01, 0.69). Mean TcPO2 was statistically significantly higher in the preoxygenation group at the end of the first suction (MD 25.00 mmHg, 95%CI 14.20, 35.80), second suction (MD 24.80, 95% CI 14.80, 34.80) and also at 120 seconds after the second suction (MD 29.10, 95% CI 14.96, 43.24). The time taken to return to baseline oxygenation status was shorter than the group not receiving preoxygenation (MD -2.12 minutes, 95% CI -3.82, -0.42).

Reviewer's conclusions: No recommendations for practice can be confidently made from the results of this review. Although preoxygenation was shown to decrease hypoxemia at the time of suctioning, other clinically important short and longer-term outcomes including adverse effects were unable to be assessed. Further studies are needed to adequately assess the effects of this widely practiced procedure.

PubMed Disclaimer

Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 Suctioning with preoxygenation vs without preoxygenation, Outcome 1 Hypoxemia end of first suction (TcPO2 <40mmHg).
1.2
1.2. Analysis
Comparison 1 Suctioning with preoxygenation vs without preoxygenation, Outcome 2 Hypoxemia end of second suction (TcP02 <40mmHg).
1.3
1.3. Analysis
Comparison 1 Suctioning with preoxygenation vs without preoxygenation, Outcome 3 Hypoxemia 120 seconds post‐suction (TcP02 <40mmHg)..
1.4
1.4. Analysis
Comparison 1 Suctioning with preoxygenation vs without preoxygenation, Outcome 4 TcPO2 end of first suction (mmHg)..
1.5
1.5. Analysis
Comparison 1 Suctioning with preoxygenation vs without preoxygenation, Outcome 5 TcPO2 end of second suction (mmHg).
1.6
1.6. Analysis
Comparison 1 Suctioning with preoxygenation vs without preoxygenation, Outcome 6 TcPO2 120 seconds post‐suction (mmHg).
1.7
1.7. Analysis
Comparison 1 Suctioning with preoxygenation vs without preoxygenation, Outcome 7 Recovery time in minutes.
1.8
1.8. Analysis
Comparison 1 Suctioning with preoxygenation vs without preoxygenation, Outcome 8 One or more episodes of bradycardia.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Walsh 1987 {published data only}
    1. Walsh C, Bada H, Korones S, Carter M, Wong S, Arheart K. Controlled supplemental oxygenation during tracheobronchial hygiene. Nursing Research 1987;36:211‐5. - PubMed

References to studies excluded from this review

Cabal 1979 {published data only}
    1. Cabal L, Devaskar S, Siassi B, Plajstek C, Waffarn F, Blanco C, Hodgman J. New endotracheal tube adaptor reducing cardiopulmonary effects of suctioning. Critical Care Medicine 1979;7:552‐5. - PubMed
Graff 1987 {published data only}
    1. Graff M, France J, Hiatt M, Hegyi T. Prevention of hypoxia and hyperoxia during endotracheal suctioning. Critical Care Medicine 1987;15:1133‐5. - PubMed

References to studies awaiting assessment

Gonzalez 2005 {published data only}
    1. Gonzalez‐Cabello H. Evaluation of antihypoxic maneuvers before tracheal aspiration in mechanically ventilated newborns. Pediatric Pulmonology 2005;39:46‐50. - PubMed

Additional references

Alpan 1984
    1. Alpan G, Glick B, Peleg O, Amit Y, Eyal F. Pneumothorax due to endotracheal tube suction. American Journal of Perinatology 1984;1:345‐8. - PubMed
Cheng 1989
    1. Cheng M, Williams PD. Oxygenation during chest physiotherapy of very low birth weight infants: Relations among fraction of inspired oxygen levels, number of hand ventilations and transcutaneous oxygen pressure. Journal of Pediatric Nursing 1989;4:411‐8. - PubMed
Downs 1978
    1. Downs J, Goldberg A. Airway Management, Mechanical Ventilation and Cardiopulmonary Resuscitation,. In: Scarpelli E, Auld P, Goldman H editor(s). Pulmonary Disease of the Fetus, Newborn and Child. Philadelphia: Lea and Febiger, 1978:99‐131.
Drew 1986
    1. Drew JH, Paddoms K, Clabburn SL. Endotracheal tube mangement in newborn infants with hyaline membrane disease. Australian Journal of Physiotherapy 1986;32:3‐5. - PubMed
Higgins 2006
    1. Higgins JPT, Green S (Editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2009. Available from www.cochrane‐handbook.org.
Hill 1982
    1. Hill A, Perlman JM, Volpe JJ. Relationship of pneumothorax to occurrence of intraventricular hemorrhage in the premature newborn. Pediatrics 1982;69:144‐9. - PubMed
Inder 2000
    1. Inder TE, Volpe JJ. Mechanisms of perinatal brain injury. Seminars in Neonatology 2000;5:3‐16. - PubMed
Macpherson 1988
    1. Macpherson TA, Shen‐Schwarz S, Valdes‐Dapena M. Prevention and reduction of iatrogenic disorders in the newborn. In: Guthrie RD editor(s). Neonatal Intensive Care. 1988:271‐92.
Mehrabani 1991
    1. Mehrabani D, Gowan CW Jr, Kopleman AE. Association of pneumothorax and hypotension with intraventricular haemorrhage. Archives of Disease in Childhood 1991;66:48‐51. - PMC - PubMed
Perlman 1983
    1. Perlman JM, Volpe JJ. Suctioning in the preterm infant: Effects on cerebral blood flow velocity, intracranial pressure and arterial blood pressure. Pediatrics 1983;72:329‐34. - PubMed
Prendiville 1986
    1. Prendiville A, Thomson A, Silverman M. Effect of tracheobronchial suction on respiratory resistance in intubated preterm babies. Archives of Disease in Childhood 1986;61:1178‐83. - PMC - PubMed
ROP Committee 1984
    1. International Committee for the Classification of Retinopathy of Prematurity. An international classification of retinopathy of prematurity. Pediatrics 1984;74:127‐33. - PubMed
Shorten 1991
    1. Shorten DR, Byrne PJ, Jones RL. Infant responses to saline instillations and endotracheal suctioning. Journal of Obstetric Gynaecological and Neonatal Nursing 1991;20:464‐9. - PubMed
Simbruner 1981
    1. Simbruner G, Coradello H, Fodor M, Havelec L, Lubec G, Pollak A. Effect of tracheal suction on oxygenation, circulation an lung mechanics in newborn infants. Archives of Disease in Childhood 1981;56:326‐30. - PMC - PubMed
Taylor 1999
    1. Taylor DL, Edwards AD, Mehmet H. Oxidative metabolism, apoptosis and perinatal brain injury. Brain Pathology 1999;9:93‐117. - PMC - PubMed
Tolles 1990
    1. Tolles CL, Stone KS. National survey of neonatal endotracheal suctioning practices. Neonatal Network 1990;9:7‐14. - PubMed
Turner 1983
    1. Turner B. Endotracheal suction in premature infants. Journal of the California Perinatal Association 1983;3:104.
Vaughan 1978
    1. Vaughan RS, Menke JA. Pneumothorax: A complication of endotracheal suctioning. Journal of Pediatrics 1978;92:633‐4. - PubMed
Woodgate 2002
    1. Woodgate PG, Flenady VJ. Tracheal suctioning without disconnection in intubated ventilated newborns. Cochrane Database of Systematic Reviews 2002, Issue 2. [DOI: 10.1002/14651858.CD003065] - DOI - PubMed
Young 1984
    1. Young CS. Recommended guidelines for suction. Physiotherapy 1984;70:106‐8. - PubMed

References to other published versions of this review

Pritchard 2001
    1. Pritchard M, Flenady V, Woodgate P. Preoxygenation for tracheal suctioning in intubated, ventilated newborn infants. Cochrane Database of Systematic Reviews 2001, Issue 3. [DOI: 10.1002/14651858.CD000427] - DOI - PMC - PubMed
Pritchard 2003
    1. Pritchard MA, Flenady V, Woodgate P. A systematic review of the role of preoxygenation for tracheal suctioning in ventilated newborn infants. Journal of Paediatric and Child Health 2003;39:163‐5. - PubMed

Publication types