Patterns of instability associated with endotracheal suctioning in infants with single-ventricle physiology

Tume, LN ORCID:, Baines, P, Guerrero, R, Johnson, R, Ritson, P, Scott, E, Arnold, P and Walsh, L 2017, 'Patterns of instability associated with endotracheal suctioning in infants with single-ventricle physiology' , American Journal of Critical care, 26 (5) , pp. 288-394.

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Background In infants with single-ventricle physiology, endotracheal suctioning poses risks because of the instability between pulmonary and systemic blood flow. Objective To examine processes and adverse events associated with endotracheal suctioning in the first 48 hours after 3 surgical procedures: the Norwood or Norwood- Sano procedure, pulmonary artery banding, and the modified Blalock-Taussig shunt. Methods Prospective observational study in a pediatric intensive care unit. Results Bedside nurses collected data from 211 episodes of endotracheal suctioning in 24 infants. Most (62%,130/211) suction episodes were unplanned; 38% (81/211) were planned. The most common reason for unplanned suctioning was arterial desaturation (48%, 62/130 episodes). The infants’ oxygen saturation levels before suctioning ranged from 27% to 86%. Serious adverse events occurred in 9% (19/211) of suction episodes. In 8 (42%) of the episodes involving a serious adverse event, the patient received no additional intravenous bolus of analgesic or muscle relaxant before suctioning; in 8 episodes (42%), the patient received both an analgesic and a relaxant; in 3 episodes (16%), the patient received either an analgesic or a relaxant but not both. More adverse events occurred with open suctioning (68%, 13/19) than with closed suctioning (32%, 6/19). Most adverse events (68%, 13/19) occurred during the night shift. Conclusions Significant hemodynamic instability and adverse events occur during routine suctioning in infants with single-ventricle physiology after surgical palliation.

Item Type: Article
Schools: Schools > School of Health and Society > Centre for Applied Research in Health, Welfare and Policy
Journal or Publication Title: American Journal of Critical care
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Funders: Alder hey Children's Hospital Charity
Depositing User: Dr Lyvonne Tume
Date Deposited: 04 Sep 2019 13:32
Last Modified: 16 Feb 2022 02:35

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