Skip to main content

Respiratory Physiotherapy and Endotracheal Suctioning During Mechanical Ventilation

  • Chapter
  • First Online:
Pediatric and Neonatal Mechanical Ventilation

Abstract

Despite widespread practice, very little high-level evidence dealing with paediatric chest physiotherapy (CPT) and endotracheal (ET) suctioning exists. Studies of mechanically ventilated paediatric, neonatal, and adult patients have shown that both interventions may cause a range of potentially serious complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Ackerman MH, Mick DJ (1998) Instillation of normal saline before suctioning in patients with pulmonary infections: a prospective randomized controlled trial. Am J Crit Care 7:261–266

    CAS  PubMed  Google Scholar 

  • Ahn Y, Hwang T (2003) The effects of shallow versus deep endotracheal suctioning on the cytological components of respiratory aspirates in high-risk infants. Respiration 70:172–178

    PubMed  Google Scholar 

  • Akgul S, Akyolcu N (2002) Effects of normal saline on endotracheal suctioning. J Clin Nurs 11:826–830

    PubMed  Google Scholar 

  • Anderson KD, Chandra R (1976) Pneumothorax secondary to perforation of sequential bronchi by suction catheters. J Pediatr Surg 11:687–693

    CAS  PubMed  Google Scholar 

  • Argent AC, Morrow BM (2004) What does chest physiotherapy do to sick infants and children? Intensive Care Med 30:1014–1016

    PubMed  Google Scholar 

  • Asher RA (1947) The dangers of going to bed. BMJ 2:967

    CAS  PubMed Central  PubMed  Google Scholar 

  • Asher MI, Douglas C, Airy M, Andrews D, Trenholme A (1990) Effects of chest physical therapy on lung function in children recovering from acute severe asthma. Pediatr Pulmonol 9:146–151

    CAS  PubMed  Google Scholar 

  • Bailey C, Kattwinkel J, Teja K, Buckley T (1988) Shallow versus deep endotracheal suctioning in young rabbits: pathologic effects on the tracheobronchial wall. Pediatrics 82:746–751

    CAS  PubMed  Google Scholar 

  • Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, Veale K, Rodriquez L, Hopkins RO (2007) Early activity is feasible and safe in respiratory failure patients. Crit Care Med 35:139–145

    PubMed  Google Scholar 

  • Barker M, Adams S (2002) An evaluation of a single chest physiotherapy treatment on mechanically ventilated patients with acute lung injury. Physiother Res Int 7:157–169

    PubMed  Google Scholar 

  • Bethune DW, Collis JM, Wotherspoon CM (1971) Endotracheal suction. Anaesthesia 26:527–529

    CAS  PubMed  Google Scholar 

  • Bilan N, Galehgolab BA, Shoaran M (2009) Medical treatment of lung collapse in children. Pak J Biol Sci 12:467–469

    CAS  PubMed  Google Scholar 

  • Boothroyd AE, Murthy BV, Darbyshire A, Petros AJ (1996) Endotracheal suctioning causes right upper lobe collapse in intubated children. Acta Paediatr 85:1422–1425

    CAS  PubMed  Google Scholar 

  • Boutros AR (1970) Arterial blood oxygenation during and after endotracheal suctioning in the apneic patient. Anesthesiology 32:114–118

    CAS  PubMed  Google Scholar 

  • Brandstater B, Muallem M (1969) Atelectasis following tracheal suction in infants. Anesthesiology 31:468–473

    CAS  PubMed  Google Scholar 

  • Branson RD (2007) Secretion management in the mechanically ventilated patient. Respir Care 52:1328–1342

    PubMed  Google Scholar 

  • Branson RD, Campbell RS, Chatburn RL, Covington J (1993) AARC Clinical Practice Guideline: endotracheal suctioning of mechanically ventilated adults and children with artificial airways. Respir Care 38:500–504

    Google Scholar 

  • Britton S, Bejstedt M, Vedin L (1985) Chest physiotherapy in primary pneumonia. BMJ 290:1703–1704

    CAS  PubMed Central  PubMed  Google Scholar 

  • Brochard L, Roudot-Thoraval F, Roupie E et al (1998) Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS. Am J Respir Crit Care Med 158:1831–1838

    CAS  PubMed  Google Scholar 

  • Button BM, Heine RG, Catto-Smith AG, Phelan PD, Olinsky A (1997) Postural drainage and gastro-oesophageal reflux in infants with cystic fibrosis. Arch Dis Child 76:148–150

    CAS  PubMed Central  PubMed  Google Scholar 

  • Button BM, Heine RG, Catto-Smith AG, Olinsky A et al (2003) Chest physiotherapy in infants with cystic fibrosis: to tip or not? A five-year study. Pediatr Pulmonol 35:208–213

    PubMed  Google Scholar 

  • Button BM, Heine RG, Catto-Smith AG, Phelan PD, Olinsky A (2004) Chest physiotherapy, gastro-oesophageal reflux, and arousal in infants with cystic fibrosis. Arch Dis Child 89:435–439

    CAS  PubMed Central  PubMed  Google Scholar 

  • Cabal L, Devaskar S, Siassi B, Plajstek C, Waffarn F, Blanco C, Hodgman J (1979) New endotracheal tube adaptor reducing cardiopulmonary effects of suctioning. Crit Care Med 7:552–555

    CAS  PubMed  Google Scholar 

  • Carpenter T (2004) Novel approaches in conventional mechanical ventilation for paediatric acute lung injury. Paediatr Respir Rev 5:231–237

    PubMed  Google Scholar 

  • Caruso P, Denari S, Ruiz SA, Demarzo SE, Deheinzelin D (2009) Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia. Crit Care Med 37:32–38

    PubMed  Google Scholar 

  • Casado-Flores J, Martinez de Azagra A, Ruiz-Lopez MJ, Ruiz M, Serrano A (2002) Pediatric ARDS: effect of supine-prone postural changes on oxygenation. Intensive Care Med 28:1792–1796

    PubMed  Google Scholar 

  • Chalumeau M, Foix-L’Helias L, Scheinmann P, Zuani P, Gendrel D, Ducou-le-Pointe H (2002) Rib fractures after chest physiotherapy for bronchiolitis or pneumonia in infants. Pediatr Radiol 32:644–647

    PubMed  Google Scholar 

  • Chaneliere C, Moreux N, Pracros JP, Bellon G, Reix P (2006) Rib fractures after chest physiotherapy: a report of 2 cases. Arch Pediatr 13:1410–1412

    CAS  PubMed  Google Scholar 

  • Choi JS, Jones AY (2005) Effects of manual hyperinflation and suctioning in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia. Aust J Physiother 51:25–30

    PubMed  Google Scholar 

  • Choong K, Chatrkaw P, Frndova H, Cox PN (2003) Comparison of loss in lung volume with open versus in-line catheter endotracheal suctioning. Pediatr Crit Care Med 4:69–73

    PubMed  Google Scholar 

  • Ciesla ND (1996) Chest physical therapy for patients in the intensive care unit. Phys Ther 76:609–625

    CAS  PubMed  Google Scholar 

  • Cignacco E, Hamers JP, Stoffel L et al (2007) The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. Eur J Pain 11:139–152

    PubMed  Google Scholar 

  • Cignacco E, Hamers JP, van Lingen RA et al (2008) Pain relief in ventilated preterms during endotracheal suctioning: a randomized controlled trial. Swiss Med Wkly 138:635–645

    PubMed  Google Scholar 

  • Clini E, Ambrosino N (2005) Early physiotherapy in the respiratory intensive care unit. Respir Med 99:1096–1104

    PubMed  Google Scholar 

  • Cobley M, Atkins M, Jones PL (1991) Environmental contamination during tracheal suction. A comparison of disposable conventional catheters with a multiple-use closed system device. Anaesthesia 46:957–961

    CAS  PubMed  Google Scholar 

  • Copnell B, Fergusson D (1995) Endotracheal suctioning: time-worn ritual or timely intervention? Am J Crit Care 4:100–105

    CAS  PubMed  Google Scholar 

  • Copnell B, Tingay DG, Kiraly NJ et al (2007) A comparison of the effectiveness of open and closed endotracheal suction. Intensive Care Med 33:1655–1662

    PubMed  Google Scholar 

  • Copnell B, Dargaville PA, Ryan EM et al (2009) The effect of suction method, catheter size, and suction pressure on lung volume changes during endotracheal suction in piglets. Pediatr Res 66:405–410

    PubMed  Google Scholar 

  • Cordero L, Sananes M, Ayers LW (2000) Comparison of a closed (Trach Care MAC) with an open endotracheal suction system in small premature infants. J Perinatol 20:151–156

    CAS  PubMed  Google Scholar 

  • Crane LD, Zombek M, Krauss AN, Auld PAM (1978) Comparison of chest physiotherapy techniques in infants with HMD. Pediatr Res 12:559

    Google Scholar 

  • Curley MA, Hibberd PL, Fineman LD et al (2005) Effect of prone positioning on clinical outcomes in children with acute lung injury: a randomized controlled trial. JAMA 294:229–237

    CAS  PubMed Central  PubMed  Google Scholar 

  • Curtis AB, Ridzon R, Vogel R et al (1999) Extensive transmission of Mycobacterium tuberculosis from a child. N Engl J Med 341:1491–1495

    CAS  PubMed  Google Scholar 

  • Day T, Farnell S, Wilson-Barnett J (2002) Suctioning: a review of current research recommendations. Intensive Crit Care Nurs 18:79–89

    PubMed  Google Scholar 

  • Dellagrammaticas HD, Kapetanakis J, Papadimitriou M, Kourakis G (1991) Effect of body tilting on physiological functions in stable very low birth weight neonates. Arch Dis Child 66:429–432

    CAS  PubMed Central  PubMed  Google Scholar 

  • Demers RR (1982) Complications of endotracheal suctioning procedures. Respir Care 29:1013–1018

    Google Scholar 

  • Demers RR, Saklad M (1973) Minimizing the harmful effects of mechanical aspiration. Heart Lung 2:542–545

    CAS  PubMed  Google Scholar 

  • Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M (1999) Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 354:1851–1858

    CAS  PubMed  Google Scholar 

  • Drew JH, Padoms K, Clabburn SL (1986) Endotracheal tube management in newborn infants with hyaline membrane disease. Aust J Physiother 32:3–5

    CAS  PubMed  Google Scholar 

  • Dreyfuss D, Saumon G (1998) Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med 157:294–323

    CAS  PubMed  Google Scholar 

  • Dupont H, Mentec H, Cheval C, Moine P, Fierobe L, Timsit JF (2000) Short-term effect of inhaled nitric oxide and prone positioning on gas exchange in patients with severe acute respiratory distress syndrome. Crit Care Med 28:304–308

    CAS  PubMed  Google Scholar 

  • Durand M, Sangha B, Cabal LA, Hoppenbrouwers T, Hodgman JE (1989) Cardiopulmonary and intracranial pressure changes related to endotracheal suctioning in preterm infants. Crit Care Med 17:506–510

    CAS  PubMed  Google Scholar 

  • Dyhr T, Bonde J, Larsson A (2003) Lung recruitment manoeuvres are effective in regaining lung volume and oxygenation after open endotracheal suctioning in acute respiratory distress syndrome. Crit Care 7:55–62

    PubMed Central  PubMed  Google Scholar 

  • Ehrhart IC, Hofman WF, Loveland SR (1981) Effects of endotracheal suction versus apnea during interruption of intermittent or continuous positive pressure ventilation. Crit Care Med 9:464–468

    CAS  PubMed  Google Scholar 

  • Emery JR, Peabody JL (1983) Head position affects intracranial pressure in newborn infants. J Pediatr 103:950–953

    CAS  PubMed  Google Scholar 

  • Evans JC, Vogelpohl DG, Bourguignon CM, Morcott CS (1997) Pain behaviors in LBW infants accompany some “nonpainful” caregiving procedures. Neonatal Netw 16:33–40

    CAS  PubMed  Google Scholar 

  • Fanconi S, Duc G (1987) Intratracheal suctioning in sick preterm infants: prevention of intracranial hypertension and cerebral hypoperfusion by muscle paralysis. Pediatrics 79:538–543

    CAS  PubMed  Google Scholar 

  • Fisher BJ, Carlo WA, Doershuk CF (1990) Fetus, newborn, child, adolescent. In: Scarpelli EM (ed) Pulmonary physiology, 2nd edn. Lea & Febiger, Philadelphia, pp 422–428

    Google Scholar 

  • Flenady VJ, Gray PH (2002) Chest physiotherapy for preventing morbidity in babies being extubated from mechanical ventilation. Cochrane Database Syst Rev 2 (2):CD000283

    Google Scholar 

  • Fox WW, Schwartz JG, Shaffer TH (1978) Pulmonary physiotherapy in neonates: physiologic changes and respiratory management. J Pediatr 92:977–981

    CAS  PubMed  Google Scholar 

  • Freytag CC, Thies FL, Konig W, Welte T (2003) Prolonged application of closed in-line suction catheters increases microbial colonization of the lower respiratory tract and bacterial growth on catheter surface. Infection 31:31–37

    CAS  PubMed  Google Scholar 

  • Galvis AG, Reyes G, Nelson WB (1994) Bedside management of lung collapse in children on mechanical ventilation: saline lavage–simulated cough technique proves simple, effective. Pediatr Pulmonol 17:326–330

    CAS  PubMed  Google Scholar 

  • Graham WG, Bradley DA (1978) Efficacy of chest physiotherapy and intermittent positive-pressure breathing in the resolution of pneumonia. N Engl J Med 299:624–627

    CAS  PubMed  Google Scholar 

  • Grasso S, Mascia L, Del Turco M et al (2002) Effects of recruiting maneuvers in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology 96:795–802

    PubMed  Google Scholar 

  • Gray PH, Flenady VJ, Blackwell L (1999) Potential risks of chest physiotherapy in preterm infants. J Pediatr 135:131

    CAS  PubMed  Google Scholar 

  • Guglielminotti J, Desmonts JM, Dureuil B (1998) Effects of tracheal suctioning on respiratory resistances in mechanically ventilated patients. Chest 113:1335–1338

    CAS  PubMed  Google Scholar 

  • Guglielminotti J, Alzieu M, Maury E, Guidet B, Offenstadt G (2000) Bedside detection of retained tracheobronchial secretions in patients receiving mechanical ventilation: is it time for tracheal suctioning? Chest 118:1095–1099

    CAS  PubMed  Google Scholar 

  • Hagler DA, Traver GA (1994) Endotracheal saline and suction catheters: sources of lower airway contamination. Am J Crit Care 3:444–447

    CAS  PubMed  Google Scholar 

  • Harding JE, Miles FK, Becroft DM, Allen BC, Knight DB (1998) Chest physiotherapy may be associated with brain damage in extremely premature infants. J Pediatr 132:440–444

    CAS  PubMed  Google Scholar 

  • Heinze H, Sedemund-Adib B, Heringlake M, Gosch UW, Eichler W (2008) Functional residual capacity changes after different endotracheal suctioning methods. Anesth Analg 107:941–944

    PubMed  Google Scholar 

  • Helder OK, Latour JM (2008) Endotracheal suctioning: there’s more to it than just technical care. Pediatr Crit Care Med 9:539–540

    PubMed  Google Scholar 

  • Hipenbecker DL, Guthrie MM (1981) The effects of negative pressure generated during endotracheal suctioning on lung volumes and pulmonary compliance. Am Rev Respir Dis 123:120

    Google Scholar 

  • Hodge D (1991) Endotracheal suctioning and the infant: a nursing care protocol to decrease complications. Neonatal Netw 9:7–15

    CAS  PubMed  Google Scholar 

  • Hoellering AB, Copnell B, Dargaville PA, Mills JF, Morley CJ, Tingay DG (2008) Lung volume and cardiorespiratory changes during open and closed endotracheal suction in ventilated newborn infants. Arch Dis Child Fetal Neonatal Ed 93:F436–F441

    CAS  PubMed  Google Scholar 

  • Ji YR, Kim HS, Park JH (2002) Instillation of normal saline before suctioning in patients with pneumonia. Yonsei Med J 43:607–612

    PubMed  Google Scholar 

  • Jolliet P, Bulpa P, Chevrolet JC (1998) Effects of the prone position on gas exchange and hemodynamics in severe acute respiratory distress syndrome. Crit Care Med 26:1977–1985

    CAS  PubMed  Google Scholar 

  • Jongerden IP, Rovers MM, Grypdonck MH, Bonten MJ (2007) Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: a meta-analysis. Crit Care Med 35:260–270

    PubMed  Google Scholar 

  • Kacmarek RM, Stoller JK (1995) Principles of respiratory care. In: Shoemaker WC, Ayres SM, Grenvik A, Holbrook PR (eds) Textbook of critical care, 3rd edn. W.B. Saunders Company, Philadelphia, p 695

    Google Scholar 

  • Kasim I, Gulyas M, Almgren B, Hogman M (2009) A recruitment breath manoeuvre directly after endotracheal suction improves lung function: an experimental study in pigs. Ups J Med Sci 114:129–135

    PubMed Central  PubMed  Google Scholar 

  • Kelleher S, Andrews T (2008) An observational study on the open-system endotracheal suctioning practices of critical care nurses. J Clin Nurs 17:360–369

    PubMed  Google Scholar 

  • Kerem E, Yatsiv I, Goitein KJ (1990) Effect of endotracheal suctioning on arterial blood gases in children. Intensive Care Med 16:95–99

    CAS  PubMed  Google Scholar 

  • Kerr ME, Rudy EB, Weber BB et al (1997) Effect of short-duration hyperventilation during endotracheal suctioning on intracranial pressure in severe head-injured adults. Nurs Res 46:195–201

    CAS  PubMed  Google Scholar 

  • Kerr ME, Sereika SM, Orndoff P et al (1998) Effect of neuromuscular blockers and opiates on the cerebrovascular response to endotracheal suctioning in adults with severe head injuries. Am J Crit Care 7:205–217

    CAS  PubMed  Google Scholar 

  • Kinloch D (1999) Instillation of normal saline during endotracheal suctioning: effects on mixed venous oxygen saturation. Am J Crit Care 8:231–240

    CAS  PubMed  Google Scholar 

  • Kiraly NJ, Tingay DG, Mills JF, Morley CJ, Copnell B (2008) Negative tracheal pressure during neonatal endotracheal suction. Pediatr Res 64:29–33

    PubMed  Google Scholar 

  • Kirilloff LH, Owens GR, Rogers RM, Mazzocco MC (1985) Does chest physical therapy work? Chest 88:436–444

    CAS  PubMed  Google Scholar 

  • Kohlhauser C, Bernert G, Hermon M, Popow C, Seidl R, Pollak A (2000) Effects of endotracheal suctioning in high-frequency oscillatory and conventionally ventilated low birth weight neonates on cerebral hemodynamics observed by near infrared spectroscopy (NIRS). Pediatr Pulmonol 29:270–275

    CAS  PubMed  Google Scholar 

  • Kornecki A, Frndova H, Coates AL, Shemie SD (2001) A randomized trial of prolonged prone positioning in children with acute respiratory failure. Chest 119:211–218

    CAS  PubMed  Google Scholar 

  • Krause MF, Hoehn T (2000) Chest physiotherapy in mechanically ventilated children: a review. Crit Care Med 28:1648–1651

    CAS  PubMed  Google Scholar 

  • Kuzenski BM (1978) Effect of negative pressure on tracheobronchial trauma. Nurs Res 27:260–263

    CAS  PubMed  Google Scholar 

  • Leslie A, Marlow N (2006) Non-pharmacological pain relief. Semin Fetal Neonatal Med 11:246–250

    PubMed  Google Scholar 

  • Lim CM, Jung H, Koh Y et al (2003) Effect of alveolar recruitment maneuver in early acute respiratory distress syndrome according to antiderecruitment strategy, etiological category of diffuse lung injury, and body position of the patient. Crit Care Med 31:411–418

    PubMed  Google Scholar 

  • Lindgren S (2007) Open and closed endotracheal suctioning: experimental and human studies. PhD Thesis, Göteborg University, Sweden

    Google Scholar 

  • Lindgren S, Almgren B, Hogman M et al (2004) Effectiveness and side effects of closed and open suctioning: an experimental evaluation. Intensive Care Med 30:1630–1637

    PubMed  Google Scholar 

  • Loubser MD, Mahoney PJ, Milligan DW (1989) Hazards of routine endotracheal suction in the neonatal unit. Lancet 1:1444–1445

    CAS  PubMed  Google Scholar 

  • Lu Q, Capderou A, Cluzel P et al (2000) A computed tomographic scan assessment of endotracheal suctioning-induced bronchoconstriction in ventilated sheep. Am J Respir Crit Care Med 162:1898–1904

    CAS  PubMed  Google Scholar 

  • Maggiore SM, Lellouche F, Pigeot J et al (2003) Prevention of endotracheal suctioning-induced alveolar derecruitment in acute lung injury. Am J Respir Crit Care Med 167:1215–1224

    PubMed  Google Scholar 

  • Main E, Stocks J (2004) The influence of physiotherapy and suction on respiratory deadspace in ventilated children. Intensive Care Med 30:1152–1159

    PubMed  Google Scholar 

  • Main E, Castle R, Newham D, Stocks J (2004) Respiratory physiotherapy vs. suction: the effects on respiratory function in ventilated infants and children. Intensive Care Med 30:1144–1151

    PubMed  Google Scholar 

  • Marcus RJ, van der Walt JH, Pettifer RJ (2002) Pulmonary volume recruitment restores pulmonary compliance and resistance in anaesthetized young children. Paediatr Anaesth 12:579–584

    CAS  PubMed  Google Scholar 

  • Marraro GA (2003) Innovative practices of ventilatory support with pediatric patients. Pediatr Crit Care Med 4:8–20

    PubMed  Google Scholar 

  • Matthews BD, Noviski N (2001) Management of oxygenation in pediatric acute hypoxemic respiratory failure. Pediatr Pulmonol 32:459–470

    CAS  PubMed  Google Scholar 

  • McCarren B, Chow CM (1996) Manual hyperinflation: a description of the technique. Aust J Physiother 42:203–208

    PubMed  Google Scholar 

  • McCarren B, Alison JA, Herbert RD (2006a) Manual vibration increases expiratory flow rate via increased intrapleural pressure in healthy adults: an experimental study. Aust J Physiother 52:267–271

    PubMed  Google Scholar 

  • McCarren B, Alison JA, Herbert RD (2006b) Vibration and its effect on the respiratory system. Aust J Physiother 52:39–43

    PubMed  Google Scholar 

  • Meyer E, Schuhmacher M, Ebner W, Dettenkofer M (2009) Experimental contamination of a closed endotracheal suction system: 24 h vs 72 h. Infection 37:49–51

    CAS  PubMed  Google Scholar 

  • Morrow BM, Argent AC (2008) A comprehensive review of pediatric endotracheal suctioning: effects, indications, and clinical practice. Pediatr Crit Care Med 9:465–477

    PubMed  Google Scholar 

  • Morrow BM, Futter MJ, Argent AC (2004) Endotracheal suctioning: from principles to practice. Intensive Care Med 30:1167–1174

    PubMed  Google Scholar 

  • Morrow B, Futter M, Argent A (2006) Effect of endotracheal suction on lung dynamics in mechanically-ventilated paediatric patients. Aust J Physiother 52:121–126

    PubMed  Google Scholar 

  • Morrow B, Futter M, Argent A (2007) A recruitment manoeuvre performed after endotracheal suction does not increase dynamic compliance in ventilated paediatric patients: a randomised controlled trial. Aust J Physiother 53:163–169

    PubMed  Google Scholar 

  • Morrow BM, Mowzer R, Pitcher R, Argent AC (2012) Investigation into the effect of closed-system suctioning on the frequency of pediatric ventilator-associated pneumonia in a developing country. Pediatr Crit Care Med 13(1):e25–32

    Google Scholar 

  • Nagaraj HS, Shott R, Fellows R, Yacoub U (1980) Recurrent lobar atelectasis due to acquired bronchial stenosis in neonates. J Pediatr Surg 15:411–415

    CAS  PubMed  Google Scholar 

  • Nicholas KJ, Dhouieb MO, Marshall TG, Edmunds AT, Grant MB (1999) An evaluation of chest physiotherapy in the management of acute bronchiolitis: changing clinical practice. Physiotherapy 85:669–674

    Google Scholar 

  • Ntoumenopoulos G, Presneill JJ, McElholum M, Cade JF (2002) Chest physiotherapy for the prevention of ventilator-associated pneumonia. Intensive Care Med 28:850–856

    CAS  PubMed  Google Scholar 

  • O’Donnell CP, Davis PG, Morley CJ (2003) Resuscitation of premature infants: what are we doing wrong and can we do better? Biol Neonate 84:76–82

    PubMed  Google Scholar 

  • Oberwaldner B (2000) Physiotherapy for airway clearance in paediatrics. Eur Respir J 15:196–204

    CAS  PubMed  Google Scholar 

  • Oh H, Seo W (2003) A meta-analysis of the effects of various interventions in preventing endotracheal suction-induced hypoxemia. J Clin Nurs 12:912–924

    PubMed  Google Scholar 

  • Pang WW, Chang DP, Lin CH, Huang MH (1998) Negative pressure pulmonary oedema induced by direct suctioning of endotracheal tube adapter. Can J Anaesth 45:785–788

    CAS  PubMed  Google Scholar 

  • Pasquina P, Tramer MR, Granier JM, Walder B (2006) Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: a systematic review. Chest 130:1887–1899

    PubMed  Google Scholar 

  • Patman S, Jenkins S, Stiller K (2000) Manual hyperinflation–effects on respiratory parameters. Physiother Res Int 5:157–171

    CAS  PubMed  Google Scholar 

  • Patman S, Jenkins S, Stiller K (2009) Physiotherapy does not prevent, or hasten recovery from, ventilator-associated pneumonia in patients with acquired brain injury. Intensive Care Med 35:258–265

    PubMed  Google Scholar 

  • Payen JF, Bru O, Bosson JL et al (2001) Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 29:2258–2263

    CAS  PubMed  Google Scholar 

  • Pelosi P, Tubiolo D, Mascheroni D et al (1998) Effects of the prone position on respiratory mechanics and gas exchange during acute lung injury. Am J Respir Crit Care Med 157:387–393

    CAS  PubMed  Google Scholar 

  • Pelosi P, Cadringher P, Bottino N et al (1999) Sigh in acute respiratory distress syndrome. Am J Respir Crit Care Med 159:872–880

    CAS  PubMed  Google Scholar 

  • Peroni DG, Boner AL (2000) Atelectasis: mechanisms, diagnosis and management. Paediatr Respir Rev 1:274–278

    CAS  PubMed  Google Scholar 

  • Perrotta C, Ortiz Z, Roque M (2007) Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database Syst Rev (1):CD004873

    Google Scholar 

  • Peter JV, Chacko B, Moran JL (2007) Comparison of closed endotracheal suction versus open endotracheal suction in the development of ventilator-associated pneumonia in intensive care patients: an evaluation using meta-analytic techniques. Indian J Med Sci 61:201–211

    PubMed  Google Scholar 

  • Pokela ML (1994) Pain relief can reduce hypoxemia in distressed neonates during routine treatment procedures. Pediatrics 93:379–383

    CAS  PubMed  Google Scholar 

  • Pritchard MA, Flenady V, Woodgate P (2003) Systematic review of the role of pre-oxygenation for tracheal suctioning in ventilated newborn infants. J Paediatr Child Health 39:163–165

    CAS  PubMed  Google Scholar 

  • Puntillo KA (1994) Dimensions of procedural pain and its analgesic management in critically ill surgical patients. Am J Crit Care 3:116–122

    CAS  PubMed  Google Scholar 

  • Rabalais G, Adams G, Stover B (1991) PPD skin test conversion in health-care workers after exposure to mycobacterium tuberculosis infection in infants. Lancet 338:826

    CAS  PubMed  Google Scholar 

  • Reines HD, Sade RM, Bradford BF, Marshall J (1982) Chest physiotherapy fails to prevent postoperative atelectasis in children after cardiac surgery. Ann Surg 195:451–455

    CAS  PubMed Central  PubMed  Google Scholar 

  • Ridling DA, Martin LD, Bratton SL (2003) Endotracheal suctioning with or without instillation of isotonic sodium chloride solution in critically ill children. Am J Crit Care 12:212–219

    PubMed  Google Scholar 

  • Roberts FE (2009) Consensus among physiotherapists in the United Kingdom on the use of normal saline instillation prior to endotracheal suction: a Delphi study. Physiother Can 61:107–115

    PubMed Central  PubMed  Google Scholar 

  • Rosen M, Hillard EK (1962) The effects of negative pressure during tracheal suction. Anesth Analg 41:50–57

    CAS  PubMed  Google Scholar 

  • Runton N (1992) Suctioning artificial airways in children: appropriate technique. Pediatr Nurs 18:115–118

    CAS  PubMed  Google Scholar 

  • Russell FE, Van Der Walt JH, Jacob J, Slater AJ, Baghurst P (2002) Pulmonary volume recruitment manoeuvre restores pulmonary compliance and resistance after apnoea in anaesthetized lambs. Paediatr Anaesth 12:499–506

    CAS  PubMed  Google Scholar 

  • Schechter MS (2007) Airway clearance applications in infants and children. Respir Care 52:1382–1390

    PubMed  Google Scholar 

  • Scoble MK, Copnell B, Taylor A, Kinney S, Shann F (2001) Effect of reusing suction catheters on the occurrence of pneumonia in children. Heart Lung 30:225–233

    CAS  PubMed  Google Scholar 

  • Shorten DR, Byrne PJ, Jones RC (1991) Infantresponses to saline instillations and endotrachealsuctioning. J Obstet Gynecol Neonatal Nurs 20:464–469

    CAS  PubMed  Google Scholar 

  • Siegel JD (2002) Controversies in isolation and general infection control practices in pediatrics. Semin Pediatr Infect Dis 13:48–54

    PubMed  Google Scholar 

  • Simbruner G, Coradello H, Fodor M, Havelec L, Lubec G, Pollak A (1981) Effect of tracheal suction on oxygenation, circulation, and lung mechanics in newborn infants. Arch Dis Child 56:326–330

    CAS  PubMed Central  PubMed  Google Scholar 

  • Singh NC, Kissoon N, Frewen T, Tiffin N (1991) Physiological responses to endotracheal and oral suctioning in paediatric patients: the influence of endotracheal tube sizes and suction pressures. Clin Intensive Care 2:345–350

    CAS  PubMed  Google Scholar 

  • Spence K, Gillies D, Waterworth L (2003) Deep versus shallow suction of endotracheal tubes in ventilated neonates and young infants. Cochrane Database Syst Rev (3):CD003309

    Google Scholar 

  • Stark AR, Waggener TB, Frantz ID, Cohlan BA, Feldman HA, Kosch PC (1984) Effect on ventilation of change to the upright posture in newborn infants. J Appl Physiol 56:64–71

    CAS  PubMed  Google Scholar 

  • Stenqvist O, Lindgren S, Karason S, Sondergaard S, Lundin S (2001) Warning! Suctioning. A lung model evaluation of closed suctioning systems. Acta Anaesthesiol Scand 45:167–172

    CAS  PubMed  Google Scholar 

  • Stiller K (2000) Physiotherapy in intensive care: towards an evidence-based practice. Chest 118:1801–1813

    CAS  PubMed  Google Scholar 

  • Stiller K, Geake T, Taylor J, Grant R, Hall B (1990) Acute lobar atelectasis. A comparison of two chest physiotherapy regimens. Chest 98:1336–1340

    CAS  PubMed  Google Scholar 

  • Suh GY, Koh Y, Chung MP et al (2002) Repeated derecruitments accentuate lung injury during mechanical ventilation. Crit Care Med 30:1848–1853

    PubMed  Google Scholar 

  • Taggart JA, Dorinsky NL, Sheahan JS (1988) Airway pressures during closed system suctioning. Heart Lung 17:536–542

    CAS  PubMed  Google Scholar 

  • Taskar V, John J, Evander E, Robertson B, Jonson B (1997) Surfactant dysfunction makes lungs vulnerable to repetitive collapse and reexpansion. Am J Respir Crit Care Med 155:313–320

    CAS  PubMed  Google Scholar 

  • Templeton M, Palazzo MG (2007) Chest physiotherapy prolongs duration of ventilation in the critically ill ventilated for more than 48 hours. Intensive Care Med 33:1938–1945

    PubMed  Google Scholar 

  • Thomas M, Fothergill-Bourbonnais F (2005) Clinical judgments about endotracheal suctioning: what cues do expert pediatric critical care nurses consider? Crit Care Nurs Clin North Am 17:329–340

    PubMed  Google Scholar 

  • Tingay DG, Copnell B, Grant CA, Dargaville PA, Dunster KR, Schibler A (2010) The effect of endotracheal suction on regional tidal ventilation and end-expiratory lung volume. Intensive Care Med 36:888–896

    CAS  PubMed  Google Scholar 

  • Tolles CL, Stone KS (1990) National survey of neonatal endotracheal suctioning practices. Neonatal Netw 9:7–14

    CAS  PubMed  Google Scholar 

  • Tume L, Jinks A (2008) Endotracheal suctioning in children with severe traumatic brain injury: a literature review. Nurs Crit Care 13:232–240

    PubMed  Google Scholar 

  • Tusman G, Bohm SH, Tempra A et al (2003) Effects of recruitment maneuver on atelectasis in anesthetized children. Anesthesiology 98:14–22

    PubMed  Google Scholar 

  • Van de Leur JP, Zwaveling JH, Loef BG, Van der Schans CP (2003) Patient recollection of airway suctioning in the ICU: routine versus a minimally invasive procedure. Intensive Care Med 29:433–436

    PubMed  Google Scholar 

  • Vandenplas Y, Diericx A, Blecker U, Lanciers S, Deneyer M (1991) Esophageal pH monitoring data during chest physiotherapy. J Pediatr Gastroenterol Nutr 13:23–26

    CAS  PubMed  Google Scholar 

  • Vivian-Beresford A, King C, MaCauley H (1987) Neonatal post-extubation complications: the preventative role of physiotherapy. Physiother Can 39:184–190

    Google Scholar 

  • Vonberg RP, Eckmanns T, Welte T, Gastmeier P (2006) Impact of the suctioning system (open vs. closed) on the incidence of ventilation-associated pneumonia: meta-analysis of randomized controlled trials. Intensive Care Med 32:1329–1335

    PubMed  Google Scholar 

  • Wallis C, Prasad A (1999) Who needs chest physiotherapy? Moving from anecdote to evidence. Arch Dis Child 80:393–397

    CAS  PubMed Central  PubMed  Google Scholar 

  • Webb MS, Martin JA, Cartlidge PH, Ng YK, Wright NA (1985) Chest physiotherapy in acute bronchiolitis. Arch Dis Child 60:1078–1079

    CAS  PubMed Central  PubMed  Google Scholar 

  • Weissman C, Kemper M, Damask MC, Askanazi J, Hyman AI, Kinney JM (1984) Effect of routine intensive care interactions on metabolic rate. Chest 86:815–818

    CAS  PubMed  Google Scholar 

  • Wood CJ (1998) Can nurses safely assess the need for endotracheal suction in short-term ventilated patients, instead of using routine techniques? Intensive Crit Care Nurs 14:170–178

    CAS  PubMed  Google Scholar 

  • Young CS (1984) Recommended guidelines for suction. Physiotherapy 70:106–108

    CAS  PubMed  Google Scholar 

  • Young J (1995) To help or hinder: endotracheal suction and the intubated neonate. J Neonatal Nurs 1:23–28

    Google Scholar 

  • Youngmee A, Yonghoon J (2003) The effects of the shallow and the deep endotracheal suctioning on oxygen saturation and heart rate in high-risk infants. Int J Nurs Stud 40:97–104

    PubMed  Google Scholar 

  • Zafiropoulos B, Alison JA, McCarren B (2004) Physiological responses to the early mobilisation of the intubated, ventilated abdominal surgery patient. Aust J Physiother 50:95–100

    PubMed  Google Scholar 

  • Zidulka A, Chrome JF, Wight DW, Burnett S, Bonnier L, Fraser R (1989) Clapping or percussion causes atelectasis in dogs and influences gas exchange. J Appl Physiol 66:2833–2838

    CAS  PubMed  Google Scholar 

  • Zmora E, Merritt TA (1980) Use of side-hole endotracheal tube adapter for tracheal aspiration. A controlled study. Am J Dis Child 134:250–254

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Brenda M. Morrow .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Morrow, B.M., Argent, A.C. (2015). Respiratory Physiotherapy and Endotracheal Suctioning During Mechanical Ventilation. In: Rimensberger, P. (eds) Pediatric and Neonatal Mechanical Ventilation. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-01219-8_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-01219-8_24

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-01218-1

  • Online ISBN: 978-3-642-01219-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics