Surgical Airway Suctioning

Excerpt

Effective management of airway secretions is essential in both acutely and chronically ill patients, particularly those with impaired ability to protect their airway. This practice is crucial in preventing life-threatening airway obstruction. Inadequate clearance of secretions can lead to poor oxygen exchange and a ventilation-perfusion (V/Q) mismatch, potentially resulting in significant clinical complications. Patients with artificial airways are susceptible to increased secretions, while individuals with neuromuscular conditions often lack the ability to clear them effectively. Additionally, sedated patients or those positioned supine or prone are unable to utilize normal postural and mechanical mechanisms to manage their secretions effectively. Reducing tracheobronchial secretions supports efficient gas exchange, improves oxygenation and alveolar ventilation, and lowers the risk of infection and atelectasis.

Visual secretions, coarse breath sounds, and increased airway resistance are key indicators that airway suctioning is necessary. A sawtooth pattern on the ventilator airflow waveform, along with elevated peak inspiratory pressure, may also signal the need for suctioning. Some ventilator systems incorporate secretion detectors that measure sound to identify excess secretions. Suctioning can be performed via the oropharyngeal or nasopharyngeal cavity, or through an endotracheal or tracheostomy tube, to remove secretions, blood, or other debris that the patient is unable to clear through swallowing, coughing, or postural adjustments.

Suctioning can be performed using either a closed or open system, which may be integrated into or external to the mechanical ventilation setup. A closed system allows for suctioning while the patient remains connected to the ventilator, maintaining oxygenation and positive pressure. Care must be taken during suctioning with a closed system to prevent the introduction of excessive negative pressure into the ventilation circuit. In contrast, an open suctioning system utilizes external supplies and requires transient discontinuation of ventilation.

Practices for the timing of suctioning can vary. Historically, many models have recommended scheduled suctioning; however, studies have shown an increased risk without any additional benefit. Current practices focus on suctioning as needed. Suctioning carries risks, including trauma, bleeding, infection, and potential disruption of the artificial airway. Emergency airway equipment must be readily available before suctioning a patient with an artificial airway to address any disruption or loss of the airway.