Preventing hypoxemia and hemodynamic compromise related to endotracheal suctioning

OBJECTIVE: To help the clinician bridge the gap between research and practice in determining ways to minimize side effects of endotracheal suctioning. DATA SOURCES: This article summarizes four previous reviews of research and studies published between 1984 and 1991 related to oxygenation techniques before, during and after endotracheal suctioning, and hemodynamic consequences of the suctioning procedure. STUDY SELECTION: Studies were reviewed by type of subject: animals, human subjects with normal lung function, and human subjects with abnormal lung function. Research of pediatric and head-injured populations was excluded from this review. DATA EXTRACTION: Oxygenation protocol, endotracheal suction characteristics, outcomes and measurement times, sample and setting, and findings were presented. CONCLUSIONS: Conclusions relate to the effectiveness of various endotracheal suction protocols on prevention of hypoxemia and hemodynamic compromise in intubated patients. DATA SYNTHESIS: An algorithm to guide clinical decision making is presented based on the conclusions of this review of the research.