Original scientific paper
https://doi.org/10.3325/cmj.2022.63.553
Evaluation of continuous aspiration of subglottic secretions in prevention of microaspiration during general anesthesia: a randomized controlled pilot study
Boris Mraovic
orcid.org/0000-0003-4019-4084
; Department of Anesthesiology & Perioperative Medicine, University of Missouri, Columbia, MO, USA
*
Brian Hipszer
; Edwards Lifesciences, Irvine, CA, USA
Channy Loeum
; Thomas Jefferson University, Philadelphia, PA, USA
Angelo Andonakakis
; Cooper University, Camden, NJ, USA
Jeffery Joseph
; Thomas Jefferson University, Philadelphia, PA, USA
* Corresponding author.
Abstract
Aim To assess the difference between endotracheal tubes
(ETT) with continuous suction of subglottic secretions
(CASS) and standard ETT in preventing secretions movement from the pharynx into the trachea, past the inflated
cuff during general anesthesia.
Methods This randomized, controlled trial enrolled 50 patients who underwent general anesthesia for elective abdominal surgery lasting longer than two hours. They received either ETT with CASS: Teleflex ISIS HVT (GISIS, n=17)
or Mallinckrodt TaperGuard Evac (GEvac, n=17), or ETT
without suction: Mallinckrodt Intermediate Hi-Lo (GStand,
n=16). Methylene blue dye solution (10 mL) was delivered
into the hypopharynx every 60 minutes. Subglottic secretions were continuously suctioned. Fiberoptic bronchoscopy was performed every 20 minutes and during tracheal
extubation to evaluate the dye location.
Results The groups did not differ in age, sex, body mass
index, race, American Society of Anesthesiologists status,
and surgery type. Dye migrated past the inflated cuff into
the distal trachea in no patient with ETT with CASS and
in 13% of patients with standard ETT. On tracheal extubation, dye migrated into the distal trachea more often in the
GStand group (56%), compared with the GEvac (13%) and
GISIS group (29%) (P=0.045). The GISIS group had 26±19
mL of secretions suctioned from above the inflated cuff,
while the GEvac group had 13±10 mL (P=0.05).
Conclusion Compared with standard ETT, ETT with CASS
efficiently removed secretions during general anesthesia,
prevented secretions from migrating past the inflated cuff,
and significantly reduced the amount of secretions that
reached the distal airways on tracheal extubation.
Keywords
Hrčak ID:
331077
URI
Publication date:
15.12.2022.
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