DISSERTATION: Lung Sounds as Indicators for Endotracheal Suctioning


Name: Joseph Schmelz

Rank: Maj, USAF

Organization: Boston College

Performance Site: Faulkner Hospital, Jamaica Plain, MA; Lemuel Shattuck Hospital, Boston, MA; Boston College, Chestnut Hill, MA

Year Published: 1995

Abstract Status: Final


Note: Dissertation available through Boston University Libraries' "Quest Library Catalog" (http://www.bc.edu/libraries/).The purpose of this study is to extend prior research on the role of adventitious lung sounds as an accurate indicator of the need for endotracheal suctioning (ETS) in adult patients requiring mechanical ventilation and endotracheal intubation. Prior research has demonstrated a link between the presence of adventitious lung sounds and secretions in the tracheobronchial tree. However, many questions still remain unanswered in relationship to: lung sound characteristics, pattern, relationship to the respiratory cycle, volume of airway secretions, and clinical decision making. The following research questions were addressed. What is the pattern of adventitious lung sounds present immediately prior to ETS? How do adventitious lung sounds patterns change after ETS? What is the relationship between adventitious lung sounds volume of tracheobronchial secretions aspirated by ETS? 4. What relationship exists between the degree of importance of rhonchi perceived by the patient's primary nurse, in the decision to suction, and rhonchi measured by computer analysis prior to suctioning? Results: Repeated measurements of fifteen subjects were analyzed. No consistent pattern of lung sounds was identified prior to suctioning. Five adventitious lung sounds were identified: rhonchi, wheezes, crackles, type II rhonchi and coarse sounds. There was a 14 percent reduction in the occurrence of adventitious lung sounds after suctioning. In addition, coarse sounds decreased in duration after suctioning in most patients. There was no relationship between lung sounds and the volume of aspirate obtained. There was also no relationship between the perceived importance of rhonchi and the actual rhonchi recorded. More importantly, the Decision to Suction Now instrument was not predictive of the volume of secretions obtained. It was concluded that the use of sputum volume obtained by blind suctioning is an unreliable measure for predicting the appropriate timing and success of suctioning. Further research using a larger population, multiple sites, acute and chronic settings, suctioning using direct visualization, and localization techniques is necessary.


Final report is available on NTRL at: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/ADA309069.xhtml