Tracheal Trauma with Suctioning: Role of ZEEP vs. PEEP

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Name: Christine Sanford

Rank: CPT, USAR

Organization: Duke University

Performance Site: Duke University Medical Center, Durham, NC

Year Published: 1996

Abstract Status: Final

Abstract

Endotracheal suctioning (ETS) is used to remove accumulated secretions and debris from the endotracheal tube and trachea of mechanically ventilated patients. This procedure is associated with a myriad of complications to include trauma to the tracheal epithelium. Closed system ETS (PEEP-positive end-expiratory pressure) methods have not been tested against open system ETS (ZEEP-zero end-expiratory pressure) for the effect on tracheal trauma. In this study we sought answers to three research questions:

  1. What is the degree of acute tracheal injury following six ETS procedures with open system suctioning as compared to closed system suctioning?
  2. Are there differences in the trajectories of tracheal epithelial regeneration over the 28 days post ETS procedure?
  3. What is the rate of growth of the trachea over the first 28 days post procedure as measured by length and inner diameter, of the control, sham and two experimental groups? Are there significant differences in the rate of growth among the groups?

The sample consisted of 94 newborn Chester-White piglets randomly divided into four groups: control (N=17), sham (N=17), PEEP (N=30) and ZEEP (N=30). The PEEP and ZEEP groups were intubated, mechanically ventilated, and received six controlled ETS procedures (one per hour) during six hours of ventilation. Piglets were euthanized immediately after the sixth ETS procedure or were allowed to recover and were later euthanized at 7, 14, 21 or 28 days post ETS. Piglets in the control and sham groups were euthanized at the same time points as piglets in the two treatment groups. All tracheas were harvested, sectioned into seven sections, stained with H&E and mounted in duplicate on glass for light microscopy analysis. Each slide was graded using video image analysis.There were significant differences between the four groups; however when closed and open suctioning were compared, there were no statistically significant differences in acute injury scores or in the scores over the first 28 days post-procedure.

 

Final report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2003102...