Two Levels of Negative Pressure in Open Tracheal Suctioning and their Effect on Cardiorespiratory Indices and Care Outcomes among Adult Patients in Critical Care Unit at Machakos Level Five Hospital

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.