Changes in lung volume with three systems of endotracheal suctioning with and without pre-oxygenation in patients with mild-to-moderate lung failure

Intensive Care Med. 2004 Dec;30(12):2210-5. doi: 10.1007/s00134-004-2458-3. Epub 2004 Oct 12.


Objective: To compare changes in lung volume, oxygenation, airway pressure, and hemodynamic effects induced by suctioning with three systems in critically ill patients with mild-to-moderate lung disease, and also to evaluate the effects of hyperoxygenation applied prior to the maneuver as suggested by some guidelines.

Design: Prospective crossover study.

Setting: General intensive care department of a university-affiliated hospital.

Patients: Ten mechanically ventilated patients with mild-to-moderate acute respiratory failure.

Interventions: Patients were ventilated in volume control mode with a mean tidal volume of 490+/-88 ml, PEEP 7+/-4 cmH2O and FiO(2) 0.36+/-0.05. Suctioning was performed sequentially with a quasi-closed system, with an open system 10 min later, and finally with a closed system. Thereafter, pure oxygen was applied for 2 min and the whole suctioning sequence was repeated in reverse order.

Measurements and main results: Patients' mean PaO(2)/FiO(2) ratio was 273+/-28 mmHg. The reductions in lung volume during suctioning were similar with the quasi-closed (386+/-124 ml) and closed system (497+/-338 ml), but significantly higher with the open system (1281+/-656 ml, P=0.022). We found no significant hemodynamic adverse effects, and no significant SpO(2) reductions with all the studied suctioning techniques. Pre-oxygenation with pure oxygen did not induce additive effects in lung volume changes. With and without pre-oxygenation, lung volume returned to baseline in every patient within 10 min.

Conclusions: Suctioning with closed and quasi-closed systems reduces the substantial losses in lung volume observed with the open system. Nevertheless, in patients without severe lung disease these changes were transient and rapidly reversible.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Blood Pressure
  • Critical Care*
  • Cross-Over Studies
  • Female
  • Heart Rate
  • Humans
  • Intubation, Intratracheal
  • Lung Volume Measurements
  • Male
  • Oxygen / administration & dosage*
  • Positive-Pressure Respiration
  • Respiratory Insufficiency / classification
  • Respiratory Insufficiency / therapy*
  • Suction / methods*


  • Oxygen