- Paper Report
- Open Access
Caution-closed suction systems!
- Jeremy Bewley1
© Biomed Central Ltd 2001
- Received: 6 April 2001
- Published: 3 December 2001
- Acute respiratory distress syndrome
- intrinsic PEEP
Closed suction systems have become popular in the airway toilet of critically ill patients who are intubated because they may reduce cross infection and prevent lung collapse and desaturation. The aim of this study was to examine their effect on ventilation using a plastic model of the lungs and trachea.
Open suctioning through a 7 mm endotracheal tube (ETT) resulted in alveolar pressures of -7 cm H20 with a 12 Fr catheter. This fell to -24 cm H2O if a 14 Fr catheter was used. During volume controlled modes, intrinsic positive end-expiratory pressure (PEEP) developed at levels up to 22 cm H2O greater than externally applied PEEP during suction through a 7 mm tracheal tube with a 14 Fr catheter. Peak inspiratory pressures rose to as high as 50 cm H2O.
Pressure controlled ventilation by contrast was much safer. Intrinsic PEEP levels of just 5 cm H2O greater than PEEP were generated, associated with a reduction in alveolar ventilation. Continuous positive airway pressure (CPAP) appeared best with minimal changes in alveolar pressure during closed system suctioning.
Lung model with rigid plastic trachea, ventilation with a Servo, alveolar and tracheal pressures were measured