Standard Tracheal Secretion Assessment vs Acoustic Secretion Detector

Endotracheal intubation and mechanical ventilation are life-saving procedures in patients with respiratory insufficiency. But this can profoundly impair the defensive mechanisms which keep the lower respiratory tract sterile, increasing the risk of bacterial colonization and ventilator-associated pneumonia. Although endotracheal suctioning is a standard of care in all mechanically ventilated patients, clear guidelines regarding the technique and timing of suctioning are lacking. The applicable American Association for Respiratory Care (AARC) guideline suggests that endotracheal suctioning should be performed at some minimum frequency or when clinically indicated. Since endotracheal suctioning can cause hypoxemia, mechanical trauma, bronchospasm, and hemodynamic instability, an accurate assessment of the need for suctioning might decrease the frequency of suctioning complications. TBA Care is a novel device designed to generate a signal when secretions are present in the respiratory tract of an intubated patient, indicating the need for endotracheal suctioning. This is the first prospective randomized trial to compare different indications for endotracheal suctioning. This study compares the efficacy of TBA Care in detecting the presence of secretions in the airways to standard indications, and also tested the hypothesis that different suctioning indications could impact the incidence of ventilator-associated pneumonia and extubation rate (Lucchini et al., 2011).

This is a quantitative research study with prospective randomized trial with 72 general intensive care unit patients randomized at intubation into 2 groups, differing only in suctioning indications. The study was conducted over a 9 month period and 72 adult patien...

... middle of paper ...

... and there is no clear indication about when to perform it. TBA Care seems to provide reliable indication of the need for suctioning. So it would be useful in critical care units. Even though the study did not find a significant difference in the occurrences of ventilator-associated pneumonia, further studies with a larger sample may be helpful. Although the nurses who did the suctioning were given training for categorizing the amount of secretion collected, further studies should get a more accurate method of measuring the quantity of secretion amount.

References

Lucchini, A., Zanella, A., Bellani, G., Gariboldi, R., Foti, G., & Pesanti, A. et al. (2011). Tracheal Secretion Management in the Mechanically Ventilated Patient: Comparison of

Standard Assessment and an Acoustic Secretion Detector. Respiratory Care, 56(5), 596-603. doi:10.4187/respcare.00909.