Endotracheal suctioning causes right upper lobe collapse in intubated children

Acta Paediatr. 1996 Dec;85(12):1422-5. doi: 10.1111/j.1651-2227.1996.tb13946.x.

Abstract

Objective: Right upper lobe collapse is a common radiographic finding in intubated children. We hypothesized that deep suctioning and uncontrolled negative pressures during endotracheal tube suctioning were significant contributory factors.

Methods: The incidence of right upper lobe (RUL) collapse in intubated, ventilated children on a paediatric cardiac intensive care unit was determined over a 3-month period (n = 102). Graduated suction catheters and suction vacuums of < 165 cm H2O were then introduced. Another prospective audit was carried out 3 months later (n = 60).

Results: We found that 24% developed RUL collapse and 4 developed an apical pneumothorax. Following the introduction of graduated catheters and controlled vacuums pressures; a significant reduction in the incidence of RUL collapse, to 7%, was observed (p < 0.05).

Conclusions: We conclude that high negative pressure and deep-suctioning causes RUL collapse in children. Any lobar collapse not only prolongs the child's stay in intensive care, but can be associated with further morbidity which may have a serious implication. By improving suctioning technique this morbidity can be significantly reduced.

MeSH terms

  • Child
  • Child, Preschool
  • Humans
  • Infant
  • Infant, Newborn
  • Intubation, Intratracheal / adverse effects*
  • Prospective Studies
  • Pulmonary Atelectasis / etiology*
  • Suction / adverse effects*