Safety and effectiveness of two levels of negative pressure in open tracheal suctioning among adult patients in critical care unit at Machakos level five hospital- a randomized controlled trial study done in Kenya

Abstract

Tracheal Tube Suctioning is an important procedure done on intubated patients receiving mechanical ventilation in order to optimize their oxygenation and ventilation. Since the advent of this procedure, the most effective and safe negative suction pressure is not yet known. This study has been carried out to establish safe and effective level of negative pressure in open tracheal tube suctioning among adult patients in Intensive Care Unit at Machakos Level Five Hospital. It was a randomized controlled double-blind study in which 76 participants were randomly allocated to either 180mmHg or to 100mmHg negative suction pressure groups to determine the pressures’ safety and effectiveness. Mann Whitney U test was used to determine the difference in the mean catheter passes between the groups and Chi-square test was used to determine the differences in the occurrence of blood-tinged secretions and Ventilator Associated Events between the two groups. The study showed that the 180mmHg suction level required significantly fewer catheter passes (x= 2.24, Mdn=2.0, SD= 0.35) compared to the ̄ 100mmHg suction level (x= 3.46, Mdn=3.5, SD = 0.55), p<0.001 with a large effect size (Hedge’s ̄g =2.66) to clear tracheal secretions. There was no statistically significant difference between the two suction pressure levels on occurrence of blood-tinged secretions and Ventilator Associated Events (p>0.05). It is concluded that the 180mmHg negative pressure is more effective in open tracheal tube suctioning than a lower negative pressure of 100mmHg without causing any additional injury ontracheal mucosa or additional risk of Ventilator Associated Events. The 180mmHg negative pressure is therefore recommended for open tracheal tube suctioning due to its effectiveness and safety compared to a lower suction level of 100mmHg.