Partially ventilated endotracheal suction. Use in newborns with respiratory distress syndrome. Closed suctioning of intubated neonates maintains better physiologic stability: a randomized trial. Closed versus open endotracheal suctioning in preterm infants: effects on cerebral oxygenation and blood volume. Lung volume and cardiorespiratory changes during open and closed endotracheal suction in ventilated newborn infants.
Ventilator adapters that permit endotracheal suction without disconnection from mechanical ventilation may overcome several of the theoretical contributors to the hypoxia and bradycardia associated with neonatal endotracheal suction. Such an adapter allows for partially ventilated endotracheal suction (PVETS) as opposed to traditional, nonventilated endotracheal suction. To test the clinical value of PVETS using an endhole adapter, changes in transcutaneous partial pressure of oxygen and heart rate were compared during paired PVETS and nonventilated endotracheal suction events on 32 occasions in 11 premature neonates with respiratory distress syndrome. Partially ventilated endotracheal suction was associated with a significant decrease in the incidence and severity of hypoxic events. Partially ventilated endotracheal suction, however, did not affect the incidence of bradycardic events; PVETS had a small but statistically significant effect on reducing the severity of bradycardia. No clear relationship between bradycardic and hypoxic events was evident. To evaluate the physiological variance in a closed (CS) vs an open suction (OS) protocol in intubated infants.
                Infants were stratified into three weight groups in a randomized crossover trial. Heart rate, respiratory rate, blood pressure, oxygen saturation, transcutaneous oxygen and carbon dioxide, and end-tidal carbon dioxide were recorded prior to suctioning, during suctioning, and recovery to baseline. Following the procedures, recovery time to baseline parameters was measured. Data were analyzed using repeated measures ANOVA.
                Overall, there was significantly less deviation from baseline physiological parameters with CS. Infants <1000 g had clinically significant decreases in heart rate with the OS method (-18% OS vs -6% CS; p=0.016). Recovery time in the OS group was twice that of the CS cohort (4 vs 2 minutes; p<0.001).
                CS maintains better physiologic stability in intubated infants. The aim of our study was to compare, using near-infrared spectroscopy (NIRS), the effects on cerebral intracellular oxygenation and cerebral blood volume (CBV) of closed endotracheal suctioning (CS), which permits continuous ventilation of the patient, with open endotracheal suctioning (OS), which requires disconnection from the ventilator. Eleven preterm infants were studied. Each patient underwent one CS, followed, after 60 min, by one OS, or vice versa, three times during the same day. Modifications in CBV and oxidized cytochrome oxidase (CytO2) were continuously detected by NIRS; arterial oxygen saturation (SaO2) heart rate (HR), transcutaneous carbon dioxide tension and mean arterial blood pressure were simultaneously recorded. Significant reductions in HR and SaO2 were observed following OS; the magnitude and duration of these negative effects of suctioning were significantly reduced with CS. In addition, the decrease in CBV was more pronounced than following CS. No changes in CytO2 concentration were seen. To compare change in lung volume (DeltaV(L)), using respiratory inductive plethysmography, time to recover pre-suction lung volume (t(rec)) and the cardiorespiratory disturbances associated with open suction (OS) and closed suction (CS) in ventilated infants.
                Randomised blinded crossover trial.
                Neonatal intensive care unit.
                Thirty neonates, 20 receiving synchronised intermittent mandatory ventilation (SIMV) and 10 high-frequency oscillatory ventilation (HFOV, four receiving muscle relaxant).
                OS and CS were performed, in random order, on each infant using a 6FG catheter at -19 kPa for 6 seconds and repeated after 1 minute.
                DeltaV(L), oxygen saturation (Spo(2)) and heart rate were continuously recorded from 2 minutes before until 5 minutes after suction. Lowest values were identified during the 60 seconds after suction.
                Variations in all measures were seen during CS and OS. During SIMV no differences were found between OS and CS for maximum DeltaV(L) or t(rec); mean (95% CI) difference of 3.5 ml/kg (-2.8 to 9.7) and 4 seconds (-5 to 13), respectively. During HFOV t(rec) was longer during OS by 13 seconds (0 to 27) but there was no difference in the maximum DeltaV(L) of 0.1 mV (-0.02 to 0.22). A small reduction in SpO(2) with CS in the SIMV group mean difference 6% (2.1 to 9.8) was the only significant difference in physiological measurements.
                Both OS and CS produced transient variable reductions in heart rate and Spo(2). During SIMV there was no difference between OS and CS in DeltaV(L) or t(rec). During HFOV there was no difference in DeltaV(L) but a slightly longer t(rec) after OS.
There is some evidence to suggest suctioning without disconnection from the ventilator improves the short term outcomes; however the evidence is not strong enough to recommend this practice as the only method of endotracheal suctioning. Future research utilising larger trials needs to address the implications of the different techniques on ventilator associated pneumonia, pulmonary morbidities and neurodevelopment. Infants less than 28 weeks also need to be included in the trials.