Effectiveness and side effects of closed and open suctioning: an experimental evaluation

Abstract

Objective: To compare the effectiveness of closed system suctioning (CSS) and open system suctioning (OSS) and the side effects on gas exchange and haemodynamics, during pressure-controlled ventilation (PCV) or continuous positive airway pressure (CPAP).

Design: Bench test and porcine lung injury model.

Participants: Twelve bronchoalveolar saline-lavaged pigs.

Setting: Research laboratory in a university hospital.

Interventions: In a mechanical lung, the efficacy of OSS and CSS with 12 and 14 Fr catheters were compared during volume-control ventilation, PCV, CPAP 0 or 10 cmH(2)O by weighing the suction system before and after aspirating gel in a transparent trachea. Side effects were evaluated in the animals with the same ventilator settings during suctioning of 5, 10 or 20 s duration.

Measurements and results: Suctioning with 12 and 14 Fr catheters was significantly more efficient with OSS (1.9+/-0.1, 2.8+/-0.9 g) and with CSS during CPAP 0 cmH(2)O (1.8+/-0.2, 4.2+/-0.5 g) as compared to CSS during PCV (0.2+/-0.2, 0.8+/-0.3 g) or CPAP 10 cmH(2)O (0.0+/-0.1, 0.7+/-0.4 g), p<0.01 (means +/- SD). OSS and CSS at CPAP 0 cmH(2)O resulted in a marked decrease in SpO(2), mixed venous oxygen saturation and tracheal pressure, p<0.001, but the side effects were considerably fewer during CSS with PCV and CPAP 10 cmH(2)O, p<0.05.

Conclusions: Irrespective of catheter size, OSS and CSS during CPAP 0 cmH(2)O were markedly more effective than CSS during PCV and CPAP 10 cmH(2)O but had worse side effects. However, the side effects lasted less than 5 min in this animal model. Suctioning should be performed effectively when absolutely indicated and the side effects handled adequately.