模拟ARDS患者闭式吸痰时导管尺寸和气管内管直径对PEEP稳定性的影响：一项实验研究

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing Pub Date : 2025-09-12 DOI:10.1016/j.iccn.2025.104233

Alberto Lucchini , Marco Giani , Chiara Maria Scala , Sonno Sara , Carluccio Salvatore , Rigaldo Simone , Andrea Restivo , Giuseppe Foti , Emanuele Rezoagli

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引用次数: 0

摘要

目的对机械通气患者进行气管内吸痰，清除气道分泌物。美国呼吸护理协会（AARC）多年来提供了气管内吸引技术和导管尺寸选择的建议（1993,2010,2022）。本研究旨在比较不同导管直径的封闭吸入系统操作对ARDS机械通气实验装置中PEEP和潮气量的影响。方法采用肺模拟器对成人重症ARDS患者进行模拟。采用两种导管尺寸（12和14 Fr）的封闭吸引系统进行气管内吸引。两根气管内管直径（7mm和8mm）。肺模拟器采用不同组合的PEEP（10、15 cmH20）、潮气量（240、420 ml）和呼吸速率（10、16、24b/min）进行通气。在吸痰前和吸痰第15秒分别评估呼气末正压和潮气量manœuvre。结果中位PEEP损失为−1.54 cmH2O (IQR:−5.93 ~−0.59)，中位潮气量损失为−153.91 ml （IQR:−213.92 ~−100.35）。单因素分析确定气管内管直径、潮气量和吸痰导管直径是影响PEEP损失的重要因素（p < 0.001），多变量分析证实了这些相关性（所有变量的p <； 0.001）。吸尿管直径是唯一与潮气量损失显著相关的因素（p < 0.001）。结论气管导管直径和潮气量对模拟成人ARDS患者闭式吸痰时PEEP损失有显著影响，吸痰导管直径对ARDS患者闭式吸痰时PEEP和潮气量损失均有显著影响。对临床实践的启示本实验结果提示，对于成年ARDS患者，吸入导管不应超过气管内管内径的50%，这是1993年AARC指南所推荐的。在这项实验台上的研究中，遵循2022年AARC的建议导致气管内吸引时PEEP水平显著降低。

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Impact of catheter size and endotracheal tube diameter on PEEP stability during closed suctioning in a simulated ARDS patient: a bench top study

Objectives

Endotracheal suctioning is performed in mechanically ventilated patients to remove airway secretions. The American Association for Respiratory Care (AARC) has provided recommendations on endotracheal suctioning techniques and catheter size selection over the years (1993, 2010, 2022). This bench-top study aimed to compare the effects of closed-suction system manoeuvres performed with different catheter diameters on PEEP and Tidal Volume in an experimental setup of mechanical ventilation in a simulated ARDS scenario.

Methods

A lung simulator was used to simulate severe ARDS in adult patients. Endotracheal suctioning was performed using a closed suction system with two catheter sizes (12 and 14 Fr). and two endotracheal tube diameters (7 mm and 8 mm). The lung simulator was ventilated with different combinations of PEEP (10,15 cmH₂0), tidal volume (240,420 ml), and respiratory rates (10,16,24b/min). PEEP and Tidal Volume were assessed both before suctioning and at the 15th second of the endotracheal suctioning manœuvre.

Results

The median PEEP loss was −1.54 cmH₂O (IQR: −5.93 to −0.59), and the median tidal volume loss was −153.91 ml (IQR: −213.92 to −100.35). Univariate analysis identified endotracheal tube diameter, tidal volume, and suction catheter diameter as significant factors influencing PEEP loss (p < 0.001), and multivariable analysis confirmed these associations (p < 0.001 for all variables). Suction catheter diameter was the only factor significantly associated with tidal volume loss (p < 0.001).

Conclusions

Endotracheal tube diameter and tidal volume significantly influenced PEEP loss, and suction catheter diameter significantly influenced both PEEP and tidal volume loss during closed suctioning in simulated adults with ARDS.

Implications for clinical practice

Results of this bench-top study suggest that, for adult patients with ARDS, the suction catheter should not exceed 50% of the inner diameter of the endotracheal tube, as recommended in the 1993 AARC guidelines. In this bench-top study, following the 2022 AARC recommendations led to a significant reduction in PEEP levels during endotracheal suctioning.

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来源期刊

Intensive and Critical Care Nursing NURSING-

CiteScore

6.30

自引率

15.10%

发文量

144

审稿时长

57 days

期刊介绍： The aims of Intensive and Critical Care Nursing are to promote excellence of care of critically ill patients by specialist nurses and their professional colleagues; to provide an international and interdisciplinary forum for the publication, dissemination and exchange of research findings, experience and ideas; to develop and enhance the knowledge, skills, attitudes and creative thinking essential to good critical care nursing practice. The journal publishes reviews, updates and feature articles in addition to original papers and significant preliminary communications. Articles may deal with any part of practice including relevant clinical, research, educational, psychological and technological aspects.