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
. 2023 Nov;68(11):1502-1509.
doi: 10.4187/respcare.10850. Epub 2023 Apr 28.

Efficacy of an Automated Secretion Removal Technology at Different Inspiratory Pressures

Anne H Nielsen  1   2 , Dan S Karbing  3 , Christoffer G Sølling  4 , Robert R Winding  1 , Stephen E Rees  5 , Nilanjan Dey  1
Affiliations

Efficacy of an Automated Secretion Removal Technology at Different Inspiratory Pressures

Anne H Nielsen et al. Respir Care. 2023 Nov.

Abstract

Background: Endotracheal suctioning is resource demanding, causes patient discomfort, and is associated with adverse effects. A new artificial cough method has been developed for automated secretion removal by using rapid deflation and inflation of the endotracheal tube cuff during the inspiratory phase of mechanical ventilation. This method has been evaluated in a bench model and in animals but not in human subjects. The aim of this study was to investigate whether this method can remove the need for endotracheal suctioning in subjects and whether this is dependent on ventilator settings.

Methods: This prospective, non-controlled study recruited 20 subjects on invasive mechanical ventilation. On the clinical need for endotracheal suctioning, the automatic cough procedure was applied 3 times over 30 s, with this repeated at higher ventilatory pressure and lower respiratory frequency if considered unsuccessful. Success was determined by removal of the clinical need for suctioning. Subject safety and comfort was measured by using the Critical-Care Pain Observation Tool before and after the procedure, and negative effects were recorded. To assess intra-subject variability, the procedure was performed on 3 different occasions for each subject.

Results: The procedure was successful in 18 of 20 subjects (90%), with mean subject success rates of 53% at low settings (peak inspiratory pressure 21.8 ± 3.8 cm H2O) and 83% at high settings (peak inspiratory pressure 25.6 ± 3.6 cm H2O). The Critical-Care Pain Observation Tool category remained unchanged in 30 procedures (77%), improved in 7 (18%), and deteriorated in 2 (5%).

Conclusions: This study illustrated the potential for significant reduction in the clinical need for endotracheal suctioning after the use of an automated artificial cough procedure at both low and high peak inspiratory pressures, and that was well tolerated.

Keywords: Tracheal secretions; artificial cough; endotracheal suctioning; mechanical ventilation.

PubMed Disclaimer

Conflict of interest statement

Drs Rees and Karbing are shareholders of AW Technologies, which manufactures the TrachFlush system evaluated in this study. The other authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Protocol flow.
Fig. 2.
Fig. 2.
Changes in the Critical-Care Pain Observation Tool category after all artificial cough procedures. CPOT = Critical-Care Pain Observation Tool.
See this image and copyright information in PMC

References

    1. Turner JS, Briggs SJ, Springhorn HE, Potgieter PD. Patients' recollection of intensive care unit experience. Crit Care Med 1990;18(9):966–968. - PubMed
    1. Granja C, Lopes A, Moreira S, Dias C, Costa-Pereira A, Carneiro A; JMIP Study Group. Patients' recollections of experiences in the intensive care unit may affect their quality of life. Crit Care 2005;9(2):R96–R109. - PMC - PubMed
    1. van de Leur JP, van der Schans CP, Loef BG, Deelman BG, Geertzen JHB, Zwaveling JH. Discomfort and factual recollection in intensive care unit patients. Crit Care 2004;8(6):R467–R473. - PMC - PubMed
    1. Maggiore SM, Lellouche F, Pignataro C, Girou E, Maitre B, Richard J-CM, et al. . Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice. Respir Care 2013;58(10):1588–1597. - PubMed
    1. Blakeman TC, Scott JB, Yoder MA, Capellari E, Strickland SL. ARRC Clinical Practice Guidelines: Artificial Airway Suctioning. Respir Care 2022;67(2):258–271. - PubMed

LinkOut - more resources