Abstract:
Tracheal Tube Suctioning is performed on intubated patients to clear secretions by
sucking them out by means of negative pressure via a suction catheter. Disparities
exist among practitioners on amount of suction pressure. Negative suction pressures
ranging from 80-300mmHg have been tested. The Nursing Council of Kenya
prescribes a suction pressure of 80-120mmHg. Suction levels beyond 200mmHg pose
risks. ICU mortality in Kenya is 38.6% compared to world-wide level of 19.9%. This
study was formulated to establish effect of open tracheal tube suctioning at 180mmHg
and 100mmHg on cardiorespiratory indices and care outcomes among mechanically
ventilated adult patients at Machakos level five county hospital. Ethical approval was
granted
by Jomo Kenyatta University Ethics Review Committee
(JKU/ISERC/02316/0914) and permit issued by NACOSTI (P/23/28497). All ethical
principles were upheld. A Randomized Controlled Trial, involving 76 mechanically
ventilated adult patients was conducted with random allocation to 180mmHg and
100mmHg suction groups in 2024. Data was collected pertaining to cardiorespiratory
indices at four suction-time points during open tracheal tube suctioning, on critical
care outcome metrics, safety and effectiveness measures and suction catheter passes
that cleared tracheal secretions. Independent t-test and Mann–Whitney U test were
used for statistical comparison of quantitative indices; Chi-square test was used to
determine homogeneity between the groups; and Repeated Measures Analysis of
Variance and Friedman test were used to assess differences in the means within each
group at Alpha level of 0.05. Results showed that the higher pressure was more
effective in tracheal secretion clearance (p < .001) and both suction levels cause
significant changes in cardiorespiratory indices (p < .05). There were significant
differences (p < .05) between the two groups on diastolic and mean arterial blood
pressure with the 100mmHg suction pressure causing bigger increment. There were
no significant differences in metric patient care outcomes, Ventilator Associated
Events and on incidences of bloody tracheal secretions (p > .05). The 180mmHg
suction pressure did not therefore show additional harm compared 100mmHg suction
level. Further research is recommended to establish the relationship between such
suctioning and tracheal mucosal damage, intracranial pressure, pneumonia and for
validation in a multi-center study.
