Endotracheal suctioning in hypoxemic patients

Abstract

Hypoxemic patients are at high risk of developing endotracheal suctioning (ES)-related complications, particularly deterioration of oxygenation and lung derecruitment, which have the potential to worsen lung injury. To prevent or limit these complications, open suctioning should be avoided and closed systems should be preferentially used. To improve cost-effectiveness, the closed system should not be changed routinely but only in case of mechanical failure or visible soiling. Suctioning should be performed only when clinically indicated, avoiding unnecessary procedures. Particular attention should be paid to technical aspects of the procedure, such as suction catheter size, the level of negative pressure, the depth of suction catheter insertion, and the duration of suctioning, which have a huge impact on ESrelated complications. Hyperoxygenation and recruiting maneuvers, particularly when performed during suctioning, can be useful in the most severely hypoxemic patients, while hyperinflation before suctioning must be avoided.