Short-term effects of endotracheal suctioning in post-cardiac arrest patients: A prospective observational cohort study

Idunn Banschbach Eggen; Gunhild Brønstad; Halvor Langeland; Pål Klepstad; Trond Nordseth

doi:10.1016/j.resplu.2022.100221

Short-term effects of endotracheal suctioning in post-cardiac arrest patients: A prospective observational cohort study

Resusc Plus. 2022 Mar 19:10:100221. doi: 10.1016/j.resplu.2022.100221. eCollection 2022 Jun.

Authors

Idunn Banschbach Eggen¹, Gunhild Brønstad¹, Halvor Langeland^{1

2}, Pål Klepstad^{1

2}, Trond Nordseth^{1

2

3}

Affiliations

¹ Department of Circulation and Medical Imaging, Faculty of Medicine and Heath Sciences, Norwegian University of Science and Technology, No-7491 Trondheim, Norway.
² Department of Anaesthesia and Intensive Care Medicine, St. Olav's University Hospital, No-7030 Trondheim, Norway.
³ Department of Anaesthesia, Molde Hospital Trust, Møre og Romsdal Health Authority, No-6412 Molde, Norway.

Abstract

Background: Endotracheal suctioning (ETS) is required in critically ill patients but may lead to adverse physiologic effects. The aim of this study was to investigate risk factors associated with adverse respiratory and circulatory effects of ETS, in post-cardiac arrest patients receiving controlled ventilation.

Methods: Patients with return of spontaneous circulation after out-of-hospital cardiac arrest were followed the first five days in the intensive care unit (ICU). For each ETS procedure performed, data were extracted from the electronic ICU records 10 min before and until 30 min after the procedure. Adverse events were defined as heart rate > 120 beats/min, systolic blood pressure > 200 or < 80 mmHg or SpO₂ < 85%. Multivariate logistic regression was applied with SpO₂ < 85% and systolic blood pressure < 80 mmHg as primary outcomes.

Results: For the 36 patients included in the study, the median number of ETS-procedures per patient was 13 (range 1-33). Oxygen desaturation occurred in 10.3% of procedures and severe hypotension in 6.6% of procedures. In the multivariate analysis, dose of noradrenaline, light sedation and oxygen desaturation prior to suctioning were associated with increased risk of oxygen desaturation. Doses of noradrenaline, suction with manual ventilation, suction in combination with patient repositioning, and first day of treatment in the ICU were significantly associated with severe hypotension.

Conclusions: The risk of circulatory and respiratory deterioration during ETS in post-cardiac arrest patients is increased the first day of ICU care, and related to sedation, dose of noradrenaline and pre-procedure hypoxemia.

Keywords: Circulatory failure; ETS, Endotracheal suctioning; Endotracheal suctioning; ICU, Intensive care unit; Invasive ventilation; MAAS, Motor Activity Assessment Scale; OHCA, Out-of-hospital cardiac arrest; PAC, Pulmonary artery catheter; PEA, Pulseless electrical activity; Post-cardiac arrest syndrome; RASS, Richmond Agitation-Sedation Scale; ROSC, Return of spontaneous circulation; SOFA, Sequential Organ Failure Assessment; Swan-Ganz.