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Managing Secretions in the Ventilated Patient: The Role of Humidification, Suction, Physiotherapy, Mucolytics and Airway Adjuncts

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Respiratory Disease and its Management

Part of the book series: Competency-Based Critical Care ((CBCC))

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Abstract

Intubation and mechanical ventilation may impair secretion clearance, adversely affect respiratory mechanics and gas exchange, and lead to significant pulmonary complications. This chapter reviews the monitoring and impact of airway secretions in the intubated patient, and describes a number of techniques used to optimise secretion clearance including humidification, suction, physiotherapy, mucolytics and the use of airway adjuncts.

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References

  1. Keller C, Brimacombe J. Bronchial mucus transport velocity in paralysed anesthetised patients: a com-parison of the laryngeal mask airway and cuffed endotracheal tube. Anesth Analg. 1998;86:1280–1282.

    Article  PubMed  CAS  Google Scholar 

  2. Konrad F, Schreiber T, Brecht-Kraus D, Georgieff M. Mucociliary transport in ICU patients. Chest. 1994; 105:237–241.

    Article  PubMed  CAS  Google Scholar 

  3. Benjamin RG, Kim CS, Chapman GA, Sackner MA. Mechanical ventilation can move secretions by two-phase gas liquid transport. Chest. 1984; 86:284.

    Google Scholar 

  4. Kim CS, Sankaran S, Eldridge MA. Mucus transport by two-phase gas-liquid flow mechanism. Am Rev Respir Dis. 1984; 129:A313.

    Google Scholar 

  5. Hess D. The evidence for secretion clearance tech-niques. Respir Care. 2001;46:1276–1293.

    PubMed  CAS  Google Scholar 

  6. Brooks D, Wilson L, Kelsey C. Accuracy and reliabil-ity of ‘specialized’ physical therapists in auscultat-ing tape-recorded sounds. Physiother Can. 1993;45:21–24.

    PubMed  CAS  Google Scholar 

  7. Dellinger R, Parrillo J, Kushnir A, Rossi M, Kushnir I. Dynamic visualisation of lung sounds with a vibration response device: a case series. Respiration. 2008;75:60–72.

    Article  PubMed  Google Scholar 

  8. Guttman J, Eberhard L, Haberthur C, et al. Detec-tion of endotracheal tube obstruction by analysis of expiratory flow signal. Intensive Care Med. 1998;24:1163–1172.

    Article  Google Scholar 

  9. Gugglielminotti J, Alzieu M, Maury E, Guidet B, Offenstadt G. Bedside detection of retained trache-obronchial secretions in patients receiving mechan-ical ventilation. Chest. 2000;118:1095–1099.

    Article  Google Scholar 

  10. Boque M, Gualis B, Sandiumenge A, Rello J. Endotra-cheal tube intraluminal diameter narrowing after mechanical ventilation: use of acoustic reflectome-try. Intensive Care Med. 2004;30:2204–2209.

    Article  PubMed  CAS  Google Scholar 

  11. Van Surrell C, Louis B, Lofaso F, et al. Acoustic method to estimate the longitudinal area profile of endotracheal tubes. Am J Respir Care Med. 1994;149:28–33.

    Google Scholar 

  12. Branson R. Secretion management in the mechanically ventilated patient. Respir Care. 2007;52:1328–1342.

    PubMed  Google Scholar 

  13. Jaber S, Pigoet J, Fodil R, et al. Long term effects of different humidification systems on endotracheal tube patency. Anesthesiol. 2004;100:782–788.

    Article  Google Scholar 

  14. Kola A, Eckerman T, Gastmeier P Efficacy of heat and moisture exchangers in preventing ventilator-associated pneumonia: meta-analysis of randomised controlled trials. Intensive Care Med. 2005;31:5–11.

    Article  PubMed  Google Scholar 

  15. Nakagawa N, Macchione M, Petrolino H, et al. Effects of heat and moisture exchanger and a heated humidification on respiratory mucus in patients undergoing mechanical ventilation. Crit Care Med. 2000;28:312–317.

    Article  PubMed  CAS  Google Scholar 

  16. Girault C, Breton L, Richard J-C, et al. Mechanical effects of airway humidification devices in difficult to wean patients. Crit Care Med. 2003;31:1306–1311.

    Article  PubMed  Google Scholar 

  17. Lindgren S, Almgren B, Hogman M, et al. Effective-ness and side-effects of closed and open suction: an experimental evaluation. Intensive Care Med. 2004;30:1630–1637.

    Article  PubMed  Google Scholar 

  18. Stiller K. Physiotherapy in intensive care. Towards and evidence-based practice. Chest. 2000;118:1801–1813.

    Article  PubMed  CAS  Google Scholar 

  19. Fernandez M, Piacentini E, Blanch L, Fernandez R. Changes in lung volume with three systems of endotracheal suction with and without pre-oxygen-ation in patients with mild-to-moderate lung failure. Intensive Care Med. 2004;30:2210–2215.

    Article  PubMed  Google Scholar 

  20. Morrow B, Futter M, Argent A. Endotracheal suction: from principles to practice. Intensive Care Med. 2004;30:1167–1174.

    Article  PubMed  Google Scholar 

  21. Masry A, Williams P, Chipman D, Kratohvil J, Kacmarek R. The impact of closed endotracheal suction systems on mechanical ventilator performance. Respir Care. 2005;50:345–353.

    PubMed  Google Scholar 

  22. Leur J P, Zwaveling JH, Loef BG, Schans CP. Endotra-cheal suction versus minimally invasive airway suction in intubated patients: a prospective ran-domised controlled trial. Intensive Care Med. 2003;29:426–432.

    PubMed  Google Scholar 

  23. Gosselink R, Bott J, Johnson M, et al. Physiotherapy for adult patients with critical illness: recommenda-tions of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med. 2008;34:1188–1199.

    Article  PubMed  CAS  Google Scholar 

  24. Berney S, Denehy L. A comparison of the effects of manual and ventilator hyperinflation on static lung compliance and sputum production in intubated and mechanically ventilated patients. Physiother Res Int. 2002;7:100–108.

    Article  PubMed  Google Scholar 

  25. Hodgson C, Denehy L, Ntoumenopoulos G, San-tamaria J, Carroll S. An investigation of the early effects of manual hyperinflation in critically ill patients. Anaesth Intensive Care. 2000;28:492–496.

    Google Scholar 

  26. Choi J, Jones A. Effects of manual hyperinflation and suction in respiratory mechanics in mechani-cally ventilated patients with ventilator-associated pneumonia. Aust J Physiother. 2005;51:25–30.

    PubMed  Google Scholar 

  27. Main E, Castel R, Newman D, Stocks J. Respiratory physiotherapy vs suction: the effects on respiratory function in ventilated infants and children. Intensive Care Med. 2004;30:1144–1151.

    Article  PubMed  Google Scholar 

  28. Maxwell L, Ellis E. Secretion clearance by manual hyperinflation: possible mechanisms. Physiother Theory Pract. 1998;14:189–197.

    Article  Google Scholar 

  29. Gregson R, Stocks J, Petley G, et al. Simultaneous measurement of force and respiratory profiles during chest physiotherapy in ventilated children. Physiol Meas. 2007;28:1017–1028.

    Article  PubMed  CAS  Google Scholar 

  30. Maclean D, Drummond G, Macpherson C, Mclaren G, Prescott R. Maximum expiratory airflow during chest physiotherapy on ventilated patients before and after the application of an abdominal binder. Intensive Care Med. 1989;15:396–399.

    Article  PubMed  CAS  Google Scholar 

  31. Savian C, Chan P, Paratz J. The effect of positive end-expiratory pressure level on peak expiratory flow during manual hyperinflation. Anesth Analg. 2005;100:1112–1116.

    Article  PubMed  Google Scholar 

  32. Berney S, Denehy L, Pretto J. Head-down tilt and manual hyperinflation enhance sputum clearance in patients who are intubated and ventilated. Aust J Physiother. 2004;50:9–14.

    PubMed  Google Scholar 

  33. Takahashi N, Murakami G, Ishikawa A, Sato T, Ito T. Anatomic evaluation of postural bronchial drainage of the lung with special reference to patients with tracheal intubation. Chest. 2004; 125:935–944.

    Article  PubMed  Google Scholar 

  34. Unoki T, Mizutani T, Toyooka H. Effects of expira-tory rib cage compression combined with endotra-cheal suction on gas exchange in mechanically ventilated rabbits with induced atelectasis. Respir Care. 2004;49:896–901.

    PubMed  Google Scholar 

  35. Rubin B. The pharmacologic approach to airway clear-ance: mucoactive agents. Respir Care. 2002;47:818–822.

    PubMed  Google Scholar 

  36. Fernandez R, Sole J, Blanch L, Artigas A. The effect of short-term instillation of a mucolytic agent (Mesna) on airway resistance in mechanically ven-tilated patients. Chest. 1995;107:1101–110.

    Article  PubMed  CAS  Google Scholar 

  37. Frass M, Dielacher C, Linkesch M, et al. Influence of potassium dichromate on tracheal secretions in critically ill patients. Chest. 2005;127:936–941.

    Article  PubMed  CAS  Google Scholar 

  38. Hendrik T, Hoog M, Lequin M, Devos A, Merkus P. DNase and atlectasis in non-cystic fibrosis paediatric. Crit Care. 2005;9:351–356.

    Article  Google Scholar 

  39. Ackerman MH and Mick DJ. Instillation of normal saline before suction on patients with pulmonary infections: a prospective randomised controlled trial. Am J Crit Care. 1998;7:261–266.

    PubMed  CAS  Google Scholar 

  40. Isea J, Poyant D, O'Donnell C, Faling L, Karlinsky J, Celli B. Controlled trial of a continuous irrigation suction catheter vs conventional intermittent suction catheter in clearing bronchial secretions from ven-tilated patients. Chest. 1993;103:1227–1230.

    Article  PubMed  CAS  Google Scholar 

  41. Schreuder F, Jones U. The effect of saline instillation on sputum yield and oxygen saturation measure-ment in adult intubated patients: single subject design. Physiotherapy. 2004;90:108–109.

    Article  Google Scholar 

  42. Jelic S, Cunningham J, Factor P. Airway hygiene in the intensive care unit. Crit Care. 2008;12:209 (doi:10.1186/cc6830).

    Article  PubMed  Google Scholar 

  43. Kim J, Davenport P, Sapienza C. Effect of expiratory muscle strength training on elderly cough function. Arch Gerontol Geriatr. 2008. Epub doi:10.1016/j. archger.2008.03.006.

    Google Scholar 

  44. Chiara T, Martin A, Davenport P, Bolser D. Expira-tory muscle strength training in persons with multiple sclerosis having mild to moderate disabil-ity: effect on maximal expiratory pressure, pulmo-nary function and maximal voluntary cough. Arch Phys Med Rehabil. 2006;87:468–473.

    Article  PubMed  Google Scholar 

  45. Bach J, Ishikawa Y, Kim H. Prevention of pulmonary morbidity for patients with Duchene muscular dys-trophy. Chest. 1997;112:1024–1028.

    Article  PubMed  CAS  Google Scholar 

  46. Bach J, Saporito L. Criteria for extubation and trache-ostomy tube removal for patients with ventilatory failure: a different approach to weaning. Chest. 1996;110:1566–1571.

    Article  PubMed  CAS  Google Scholar 

  47. Chatwin M, Ross E, Hart N, Nickol A, Polkey M, Simonds A. Cough augmentation with mechanical insufflation/exsufflation in patients with neuromus-cular weakness. Eur Respir J. 2003;21:502–508.

    Article  PubMed  CAS  Google Scholar 

  48. Sancho J, Servera E, Vergara P, Marin J. Mechanical insufflation-exsufflation vs. tracheal suction via tra-cheostomy tubes for patients with amyotrophic lateral sclerosis. Am J Phys Med Rehabil. 2003;82:750–753.

    Article  PubMed  Google Scholar 

  49. Roberts K, Whalley H, Bleetman A. The nasopha-ryngeal airway: dispelling myths and establishing the facts. Emerg Med J. 2005;22:394–396.

    Article  PubMed  CAS  Google Scholar 

  50. Balkan M, Ozdulger A, Tastepe I, Kaya S, Cetin G. Clinical experience with minitracheostomy. Scand J Thorac Cardiovasc Surg. 1996;30:93–96.

    PubMed  CAS  Google Scholar 

  51. Vianello A, Bevilacqua M, Arcaro G, et al. Non-invasive ventilatory approach to treatment of acute respiratory failure in neuromuscular disorders. A comparison with endotracheal intubation. Intensive Care Med. 2000;26:384–390.

    Article  PubMed  CAS  Google Scholar 

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Ntoumenopoulos, G. (2009). Managing Secretions in the Ventilated Patient: The Role of Humidification, Suction, Physiotherapy, Mucolytics and Airway Adjuncts. In: McLuckie, A. (eds) Respiratory Disease and its Management. Competency-Based Critical Care. Springer, London. https://doi.org/10.1007/978-1-84882-095-1_14

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  • DOI: https://doi.org/10.1007/978-1-84882-095-1_14

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-094-4

  • Online ISBN: 978-1-84882-095-1

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