None listed
Conditions
Brief summary
Infants on ventilatory support in neonatal intensive care regularly require suction to clear their airways of secretions. This process entails the introduction of a catheter into the endotracheal tube through which the infant is ventilated to suction the secretions. There are two brief episodes of disconnection from the ventilator (to remove then reinsert the flow measurement device, or pneumotachograph) before and after the suctioning. Although this is a necessary process, some infants experience a reduction in oxygenation possibly due to lung collapse from this procedure. In the past we did not have any good monitoring tool to assess the changes occurring in lung volume during and after suction in ventilated newborn infants. Electrical impedance tomography (EIT) is a new non-invasive lung volume monitoring tool, which is well suited to this purpose. Our study group has shown that EIT measures ventilation distribution highly accurately and gives information on the level of lung inflation in preterm infants. The purpose of the study is to attempt to examine the effect of endotracheal suction on ventilation distribution and lung de-recruitment in preterm infants.
Interventions
The intervention consists of removal of the flow sensor followed by suctioning via a Bodai suction port using a 6-F catheter in infants on conventional ventilation. Each suction procedure will consist of approximately and will consist of 2 suction passes and conclude with re-insertion of the flow sensor back into the ventilatory circuit. Only one suction intervention will be measured and the entire procedure will take a maximum of 10 minutes.
Sponsors
Judy Hough
Eligibility
Sex/Gender
All
Age
0 to 7 Days
Healthy volunteers
No
Inclusion criteria
Gestation less than 32 weeks gestation (i.e. up to and including 31 weeks 6 days gestation) Less than 7 days of age at onset of endotracheal ventilation Birth weight of more than 750 grams Duration of ventilation at enrolment of at least 12 hours Expected to continue to receive mechanical ventilation before and after at least one episode of airway suction after enrolment Satisfactory endotracheal tube position has been determined by chest radiograph Arterial sampling line in situ (umbilical or extremity) Parent(s) able and willing to provide informed consent
Exclusion criteria
Air leak syndrome (e.g. pneumothorax, pneumomediastinum, pulmonary interstitial emphysema Lung or cardiovascular anomaly that would substantially affect oxygenation, lung recruitment or regional ventilation, e.g; o cyanotic or other major congenital heart disease (not including Patent Ductus Arteriosus) o tracheo-oesphageal fistula o space occupying thoracic lesion such as diaphragmatic hernia or eventration, or cystic adenomatoid malformation Substantial leak around endotracheal tube (e.g.. >50%) precluding accurate non-invasive measurement of respiratory function Significant hemodynamic instability (untreated shock, hypovolemia, hypotension) Poor skin integrity precluding the use of adhesive electrocardiogram (ECG) electrodes. Survival considered unlikely (death considered imminent or inevitable). Both parents of baby under 18 years of age due to the complexities of obtaining consent.
Outcome results
None listed