Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice

BACKGROUND: Little is known about the incidence of and risk factors for adverse effects from endotracheal suctioning. We studied the incidence and risk factors, and evaluated the effect of suctioning practice guidelines. METHODS: During a 3-month period, in 79 mechanically ventilated subjects, we recorded the adverse effects in 4,506 suctioning procedures. Then practice guidelines were implemented, and 1 year later, during another 3-month period, in 68 subjects, we recorded the adverse effects in 4,994 suctioning procedures. RESULTS: In the first period, adverse effects occurred frequently: oxygen desaturation in 46.8% of subjects and 6.5% of suctionings, hemorrhagic secretions in 31.6% of subjects and 4% of suctionings, blood pressure change in 24.1% of subjects and 1.6% of suctionings, and heart rate change in 10.1% of subjects and 1.1% of suctionings. After guidelines implementation, all complications, both separately and all together, were reduced. The incidence of all complications together decreased from 59.5% to 42.6% of subjects, and from 12.4% to 4.9% of procedures (both P < .05). PEEP > 5 cm H2O was an independent risk factor for oxygen desaturation. Receiving > 6 suctionings per day was a risk factor for desaturation and hemorrhagic secretions. The use of guidelines was independently associated with fewer complications. CONCLUSIONS: Endotracheal suctioning frequently induces adverse effects. Technique, suctioning frequency, and higher PEEP are risk factors for complications. Their incidence can be reduced by the implementation of suctioning guidelines.