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Evaluation of antihypoxemic maneuvers before tracheal aspiration in mechanically ventilated newborns
Author(s) -
GonzálezCabello Héctor,
Furuya María E.Y.,
Vargas Mario H.,
Tudón Hugo,
Garduño Juan,
GonzálezAyala Jorge
Publication year - 2005
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.20130
Subject(s) - medicine , hyperventilation , hyperoxia , anesthesia , hypoxemia , ventilation (architecture) , pulse oximetry , pco2 , lung , mechanical engineering , engineering
Periodical tracheal aspiration in mechanically ventilated patients is necessary to remove mucus from the airways. In children and adults, this procedure causes transient hypoxemia, which may be prevented by hyperoxia and/or hyperventilation. These findings, however, have not been sufficiently assessed in newborn infants. Thus we investigated the usefulness of hyperoxia and/or hyperventilation as antihypoxemic maneuvers before tracheal aspiration in newborn infants. Our design was a prospective, randomized, multiple crossover study. The setting was the NICU of a third‐level pediatric hospital in Mexico City. Patients included 15 newborn infants under mechanical ventilation. Within a 12‐hr period, every patient received, in random order, three antihypoxemic maneuvers during 1 min just before tracheal aspiration: hyperoxia (10% increase of baseline FiO 2 ), hyperventilation (50% increase of ventilator cycling rate), or both. Additionally, a control (sham) maneuver was also applied. Pulse oximeter saturation (SpO 2 ) was recorded before and after each antihypoxemic maneuver, and at 0, 15, 30, 60, and 300 sec after tracheal aspiration. Basal values of SpO 2 (81.5 ± 1.5%) increased with all three antihypoxemic maneuvers (SpO 2 over 90%, P < 0.05 to P < 0.01). Immediately after tracheal aspiration a drop in the SpO 2 could be detected in all infants. However, patients receiving hyperoxia showed higher SpO 2 values (87.1 ± 1.8%) than those observed with the sham maneuver (76.9 ± 2.3%, P < 0.01). From this point on, all newborn infants in all conditions (even those with sham maneuver) had spontaneous increments of SpO 2 that at 300 sec were again higher than their respective basal values ( P < 0.05 to P < 0.0005). At this time, SpO 2 values from following the hyperoxia maneuver were still higher than those following the sham maneuver ( P < 0.05). Our results show that, similar to what occurs at other ages, tracheal aspiration in mechanically ventilated newborn infants causes transient hypoxemia, which can be partially prevented by previous application of antihypoxemic maneuvers, especially hyperoxia. Pediatr Pulmonol. 2005; 39:46–50. © 2005 Wiley‐Liss, Inc.