Effects on Lung Gas Volume, Respiratory Mechanics and Gas Exchange of a Closed-Circuit Suctioning System during Volume- and Pressure-Controlled Ventilation in ARDS Patients

Davide Chiumello; Luca Bolgiaghi; Paolo Formenti; Tommaso Pozzi; Manuela Lucenteforte; Silvia Coppola

doi:10.3390/jcm10235657

Effects on Lung Gas Volume, Respiratory Mechanics and Gas Exchange of a Closed-Circuit Suctioning System during Volume- and Pressure-Controlled Ventilation in ARDS Patients

J Clin Med. 2021 Nov 30;10(23):5657. doi: 10.3390/jcm10235657.

Authors

Davide Chiumello^{1

2

3}, Luca Bolgiaghi¹, Paolo Formenti¹, Tommaso Pozzi², Manuela Lucenteforte², Silvia Coppola¹

Affiliations

¹ Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Via di Rudini 9, 20122 Milan, Italy.
² Department of Health Sciences, University of Milan, 20122 Milan, Italy.
³ Coordinated Research Center on Respiratory Failure, University of Milan, 20122 Milan, Italy.

Abstract

Mechanically ventilated patients periodically require endotracheal suctioning. There are conflicting data regarding the loss of lung gas volume caused by the application of a negative pressure by closed-circuit suctioning. The aim of this study was to evaluate the effects of suctioning performed by a closed-circuit system in ARDS patients during volume- or pressure-controlled ventilation. In this prospective crossover-design study, 18 ARDS patients were ventilated under volume and pressure control applied in random order. Gas exchange, respiratory mechanics and EIT-derived end-expiratory lung volume (EELV) before the suctioning manoeuvre and after 5, 15 and 30 min were recorded. The tidal volume and respiratory rate were similar in both ventilation modes; in volume control, the EELV decreased by 31 ± 23 mL, 5 min after the suctioning, but it remained similar after 15 and 30 min; the oxygenation, PaCO₂ and respiratory system elastance did not change. In the pressure control, 5 min after suctioning, EELV decreased by 35 (26-46) mL, the PaO₂/FiO₂ did not change, while PaCO₂ increased by 5 and 30 min after suctioning (45 (40-51) vs. 48 (43-52) and 47 (42-54) mmHg, respectively). Our results suggest minimal clinical advantages when a closed system is used in volume-controlled compared to pressure-controlled ventilation.

Keywords: ARDS; EIT; closed-circuit suctioning; endotracheal suctioning.