Comparison of three different suctioning pressures in terms of efficiency and complication for intubated patients applied open system endotracheal suctioning

This research was planned as a self-controlled designed, prospective experimental study with the purpose of comparing the influence of three different suction pressures on the intubated intensive care patients with respect to the patients' hemodynamic parameters (mean arterial blood pressure, heart rate), SpO2 and arterial blood gas values, amount of secretion and complication development (hypoxemia, bradycardia, tachycardia, hypotension, hypertension and tracheal mucosal injury). The research was carried out in the Anesthesiology and Reanimation Intensive Care Unit (ARICU) of Turkish Republic Ministry of Health University of Health Sciences Tepecik Training and Research Hospital. The study population consists of 356 intubated and mechanically ventilated patients at ARICU between the dates of February 1st 2016 and March 13th 2017. The study sample included 47 patients who met the research inclusion criteria. The research data were gathered from several data sources including "Patient Identification and Follow Up Form", "Open System Suction Method Application Guide", and "Guide for Blood Gas Collection from Arterial Cannula". For analyzing the data obtained in this study, number, percentile, median, standard deviation, repeated measures analysis of variance, and Bonferroni test were employed. The analysis of the research findings did not reveal any significant difference (p<0.05) among the three different suction pressures (80 mmHg, 150 mmHg, 250 mmHg) which were applied to the patients with respect to the patients' hemodynamic parameters (mean arterial blood pressure, heart rate), SpO2 and arterial blood gas values (PaO2, PaCO2, SaO2, pH), bradycardia, tachycardia, hypotension, hypertension and tracheal mucosal injury). For each group (80 mmHg, 150 mmHg, 250 mmHg), in respect of the measuring periods, the difference among the patients' heart rate, MAP, SpO2 mean values were found very significant (p<0.001) whereas the difference among the arterial blood gas values of PaO2, PaCO2, SaO2, pH means were found significant (p<0.05). In this research it was determined that the amount of the suctioned secretion was tended to increase along with the increased pressure and there was a statistically very significant difference (p<0.001) among the pressure levels with respect to the medians of the amount of the suctioned secretion. It was also observed that, once the suction was ended, the frequency of need for repeated suction tended to decrease along with the elevated levels of suction pressure and there was a statistically significant difference (p<0.05) among the pressure levels regarding the need for repeated suction once the suction was ended. In this research, tachycardia, bradycardia, hypoxemia, tracheal mucosal injury or mucosal bleeding related complication development was not observed during the suction for none of the suction induced patients with three different pressures. The difference among the temporary oxygen desaturation rates observed during the suction in respect of pressure levels and the temporary hypertension rates observed during the suction in respect of pressure levels was not found statistically significant (p>0.05). Consequently, the results of this study did not support the hypothesis, which suggests that the 250 mmHg suction pressure may influence the hemodynamic parameters, blood gas values, and complication development occurrences during and after suction comparatively more than the 80 and 150 mmHg suction pressures. It may be propounded that the 250 mmHg suction pressure, via compliance with the open system suction method related procedures, is being more effective and equally safe for secretion cleaning in comparison to the 80 and150 mmHg suction pressures. Key words: Endotracheal suctioning; suction pressure; complication; open system suction; intensive care patients