Preventing Suctioning-Induced Hypoxemia at Altitude

Nurses routinely perform endotracheal suctioning (ETS) to maintain airway patency and adequate oxygenation in the mechanically ventilated patient. Standard technique involves the administration of 1 to 4 hyperoxygenation breaths at an inspired oxygen concentration of 100% (FiO₂ 1.0). Although broad, the research base for ETS does not include environmental factors routinely encountered by military nurses (e.g. altitude and shock) that may impact oxygenation. The goal of this study is to determine the impact of various altitudes on preventative measures to prevent suctioning induced hypoxemia using off versus on vent ETS in both normal and hypovolemic shock states. The specific aims are to: 1) determine if hyperoxygenation measures prevent hypoxemia after suctioning at different altitudes both in normovolemic and hypovolemic states, and 2) determine the effect of off ventilator ETS versus on ventilator ETS on physiologic measures of hypoxemia at different altitudes both in normovolemic and hypovolemic states. To address these aims the following research questions will be addressed: 1) Does hyperoxygenation-hyperventilation-hyperinflation prior to and immediately following endotracheal suctioning prevent hypoxemia at altitudes of 0, 6000, 8000, 10,000 feet in normovolemic and hypovolemic states? and 2) What are the effects of off ventilator ETS versus on ventilator ETS on systolic and diastolic arterial pressure, mean arterial pressure, heart rate, airway pressure, arterial blood gases, and pulse oximetry at altitudes of 0, 6000, 8000, and 10,000 feet in normovolemic and hypovolemic states? These research questions will be answered using a repeated measures mixed design, using a porcine (pig) animal model with two groups (normovolemic and hypovolemic states). The results of this study have the potential of directly impacting routine nursing care currently provided by military nurses in the aeromedical evacuation system.

Final Report is available on NTRL at: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2013104...