None listed
Conditions
Brief summary
Cardiac surgery utilising cardiopulmonary bypass (CPB) is one of the most common forms of major surgery, with more than 1 million patients undergoing this surgery worldwide each year, including around 2500 in New Zealand (MOH 2008). After cardiac surgery the patients are admitted to the Intensive Care Unit, where they remain until ready for transfer to the surgical ward. The uncomplicated patient is ventilated for between 3-12 hours and woken up once they are cardiovasculary stable. When patients are ventilated part of the routine care includes nurses performing endotracheal suction (ETT Suction). The principle of ETT suction is to maintain pulmonary hygiene in patients who have lost the natural ability to cough and protect their airway as a result of the ETT being in place. Other principles include maintaining patency of the ETT tube, preventing aspiration and removing secretions. One of the main complications of the ETT is the increased risk of infection, e.g. pneumonia, but it can also lead to trauma to the lung tissue, hypoxia, bradycardia and hypertension. The bulk of the current evidence for performing ETT suction in ICU has been based upon patients who have been ventilated for longer than 3 days and frequently have underlying lung disease or injury. Both these conditions require long-term ventilation and have specific oxygenation requirements. The uncomplicated postoperative cardiac patient is ventilated for a few hours after surgery, usually until they are warm and cardiovascularly stable. The aim is to extubate these patients as soon as it is safe and appropriate to do so. There is some recent evidence that the effect of ETT suction is longer lasting than anticipated particularly in the spontaneously breathing patient ETT suction causes a loss of lung volume and positive end expiratory pressure. There appears to be no evidence about the safety and efficacy of not performing ETT suction in this group of patients. This study aims to determine if avoiding ETT suction in the routine postoperative cardiac patient ventilated for less than 12 hours has a deleterious effect. Hypothesis: Avoiding ETT suction in patients following cardiac surgery is not inferior to usual care of mandated suction prior to extubation.
Interventions
The avoidance of endotracheal (ETT) suction in patients undergoing planned cardiac surgery,who are ventilated for less than 12 hours. ETT suction is normally performed "as required". It is at the discretion of the bedside nurse and can vary from 2 hours to 4 hours. The aim of ETT suction is to maintain pulmonary hygiene, clear any secretions that the patient cannot remove by coughing. It also aims to maintain integrity of the the ETT.
Those patients in the intervention group, i.e. no suction,
The avoidance of endotracheal (ETT) suction in patients undergoing planned cardiac surgery,who are ventilated for less than 12 hours. ETT suction is normally performed "as required". It is at the discretion of the bedside nurse and can vary from 2 hours to 4 hours. The aim of ETT suction is to maintain pulmonary hygiene, clear any secretions that the patient cannot remove by coughing. It also aims to maintain integrity of the the ETT. Those patients in the intervention group, i.e. no suction, will have all the usual care of the post operative cardiac patient, however with no ETT being performed. All the usual ICU monitoring will be in use and there are no plans for earlier extubation of this group. There are predefined criteria for the non-suction group to receive suction if required and for patient safety. It is intended that a data safety committee will be established and review the first 20 patients to ensure protocol compliance and patient safety.
Sponsors
Eileen Gilder
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Equal to or greater than 16 years old, 2. Patients having cardiac surgery with cardiopulmonary bypass (CPB), 3. Extubation expected within 12 hours of admission to CVICU
Exclusion criteria
1. Documented difficult intubation 2. Expected ventilation >12 hours 3. Clinician preference for the patient to receive ETT suction.
Outcome results
None listed