Increasing suction pressure during endotracheal suctioning increases the volume of suctioned secretions, but not procedure-related complications: A comparative study in open system endotracheal suctioning

Investigation of pain associated with endotracheal aspiration and affecting factors in an intensive care setting: A prospective observational study

BACKGROUND

Endotracheal aspiration is a painful nociceptive procedure. There is still a gap in the literature on studies to determine the pain level and nursing interventions for aspiration.

OBJECTIVES

This study evaluated pain during endotracheal aspiration and examined the factors affecting pain.

METHODS

This prospective observational study was conducted with 105 inpatients meeting the inclusion criteria in the internal intensive care unit of a public hospital. Two hundred ten aspiration procedures were monitored for pain and other variables. ASPMN 2019 Position Statement recommendations were followed in designing the study and determining the procedure. The pain score range obtained from The Critical Care Pain Observation Tool was 0-8. A score of 2 or more is considered to indicate the presence of pain. The primary outcome measures were pain associated with endotracheal aspiration and affecting factors in this study. The generalised linear mixed model established for aspiration procedure-associated pain and affecting factors was analysed.

RESULTS

Patients' mean pain score was 1.24 ± 2.05 before, 3.07 ± 2.17 during, and 2.35 ± 1.94 after aspiration and 0.89 ± 1.40 at 15 min after aspiration. The pain rate was 26.1% before, 71% during, and 60.9% after the aspiration procedure and 18.8% after 15 min. There was a statistically significant difference between all pain scores evaluated. The difference in aspiration-related pain scores by age, respiratory diseases, sedation status, aspiration pressure, and tube diameter was statistically significant.

CONCLUSIONS

The pain score due to aspiration procedure increased significantly in intensive care unit inpatients and is an important risk factor for patient safety. More focus is needed on the causes and measures of aspiration-related pain.

Study On Device System to Reduce Tracheal Mucosal Injury in Intubation Patients

The purpose of this study was to develop an automatic bronchial aspiration system to minimize tracheal mucosal damage in ventilator patients. Operation performances of the system's suction pressure, bronchial intubation depth, suction cycle, and tube cuff pressure were tested. To check clinical results, subjects underwent endoscopy after applying the previous manual method for 24 hours. After that, they underwent endoscopy after applying the proposed suction system for 24 hours. For quantitative evaluation of test results, tracheal mucosal injury was divided into five grades: Grade 0 = normal, Grade 1 = erythema or edema, Grade 2 = erosion, Grade 3 = hemorrhage, and Grade 4 = ulcer or necrosis. In the performance test, an error of up to 12 mmHg occurred within the normal operation error range for suction pressure control. The insertion depth control had a maximum error of 7.0 mm within the normal operation error range. On the other hand, there was no error in the time control or the tube cuff pressure control. In the clinical trial, after using the proposed system for five subjects to find changes in tracheal mucosal injury by endoscopy, reduced injury or no change in injury was found. The system proposed in this study is confirmed to be able to remove sputum while minimizing tracheal mucosal injury that can occur when using previous manual suction device.