Comparison of loss in lung volume with open versus in-line catheter endotracheal suctioning
Bibliographic record
Abstract
OBJECTIVE: Disconnecting the endotracheal tube from the ventilator causes significant loss in lung volume, which is further exacerbated by suctioning. In-line catheter suction systems have putative benefits over open catheter suction by maintaining positive pressure, thereby minimizing hypoxemia and hemodynamic instability. However, there is a theoretical risk of generating large negative airway pressures and auto-cycling of the ventilator with in-line catheter suction systems. We studied the effects on lung volume with both these techniques. DESIGN: Open, randomized, crossover, clinical trial. SETTING: Pediatric critical care unit. PATIENTS: Fourteen paralyzed patients, age 6 days to 13 yrs. INTERVENTIONS: Each patient, acting as his or her own control, was suctioned with an in-line catheter suction system and open catheter suction. Each suction maneuver was standardized. Changes in lung volume were measured by inductance plethysmography. Heart rate, blood pressure, and oxygen saturation were continuously monitored. MEASUREMENTS AND MAIN RESULTS: Total lung volume loss was greater with open catheter suction compared with in-line catheter suction systems (p = .008). The most significant amount of lung volume loss associated with open catheter suction appears to be related to ventilator disconnection, rather than actual suctioning. Patients with decreased pulmonary compliance (< 0.8 mL/cm H2O/kg) demonstrated a greater loss in lung volume, both absolute and relative, as a result of ventilator disconnection (p = .038 and .006, respectively). Patients suctioned with open catheter suction desaturated to a greater extent than patients suctioned with in-line catheter suction (p = .026). There was evidence of ventilator triggering during the actual suction maneuver in all patients during in-line catheter suctions. CONCLUSIONS: The most significant loss in lung volume during suctioning occurs primarily during ventilator disconnection. Hence, open catheter suction results in greater lung volume loss when compared with in-line catheter suction. We suggest that in-line catheter suction is preferable, especially in patients with significant lung disease and who require high positive end-expiratory pressures, to avoid alveolar derecruitment and exacerbating hypoxemia during endotracheal tube suctioning.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".