Endotracheal aspiration

Bronchial crackles indicate the presence of abundant tracheobronchial secretion. An increase in peak pressures during volume-controlled ventilation or a decrease in tidal volumes during controlled-pressure ventilation are also good indicators of bronchial sputum retention.

An aspiration catheter is inserted into the trachea. Once the catheter is positioned in the lower part of the bronchial tree, suction is applied. The tube is then slowly withdrawn over a period of 10 to 15 s with suction applied. The inspired oxygen fraction FiO 2 must be increased for several minutes before and after the procedure in order to reduce secondary hypoxia.

The diameter of the aspiration catheter must not exceed half the internal diameter of the endotracheal tube. Single-use flexible tubes are preferable. Instillations of 5 to 10 ml of isotonic saline solution are sometimes required when secretions are thick and tenacious.

Tracheobronchial ulcers can occur, and may bleed or become infected. The causes of these ulcers depend on the rigidity, the number of lateral perforations, the diameter of the aspiration catheter, the shape of the distal tip, and the frequency of tracheobronchial aspiration. Suction of over 200 mmHg exposes the patient to the risk of pulmonary atelectasis as well as invagination of tracheobronchial mucosa through the port of the aspiration catheter. Infection can be caused by introduction of exogenous bacteria into the trachea or contamination of the patient by his or her own flora. Severe hypoxia can occur when a patient is disconnected from the ventilator. There may also be cardiac arrhythmia or even cardiac arrest.

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