Effects of Open and Closed Tracheal Suctioning on Pain in Mechanically Ventilated Patients

Fatemeh Khayer, Somayeh Ghafari, Mahmoud Saghaei, Ahmadreza Yazdannik, Vajihe Atashi

Abstract


Background: Painful care procedures are the most common cause of stress in patients admitted to Intensive Care Units (ICUs). Tracheal suctioning is the most painful experience for ICU patients. The present study was conducted to compare open and closed endotracheal suctioning in terms of their effect in pain in mechanically ventilated patients.

Materials and Methods: The present clinical trial recruited 70 mechanically ventilated patients with tracheostomy in 2019. The eligible patients were randomly divided into open and closed suctioning groups. The pain was measured in the patients using the Critical Pain Observational Tool (CPOT) before and during suctioning as well as 10 and 30 min later. The data were analyzed using the repeated measures Analysis Of Variance (ANOVA), paired t‑test, and Chi‑squared test.

Results: The pain score was significantly higher in the open suctioning group during (t = 2.59, p = 0.01) and 10 min after suctioning (t = 3.02, p = 0.004). No significant differences were observed in the pain score between the two groups 30 min after suctioning (t = 0.32, p = 0.75). The post hoc Least Significant Difference (LSD) test showed that the CPOT scores 10 min after suctioning was significantly higher than that before suctioning and significantly lower than that during suctioning (p = 0.001). The CPOT score 30 min after suctioning was also significantly lower than that 10 min after suctioning (p < 0.001).

Conclusions: The present findings suggested a lower pain in the patients with closed suctioning compared to those with open suctioning.



Keywords


Interactive ventilatory support, pain, suction

Full Text:

PDF

References


Paymard A, Khalili A, Zoladl M, Dehghani F, Zarei Z, Javadi M. A comparison of the changes in pain and discharge in open endotracheal suction catheters with two sizes of 12 and 14: A randomized clinical trial. Qom Univ Med Sci J 2017;10:1‑8.

Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJ, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 2018;46:825‑73.

Ying X, Zhang H, Qian L. Endotracheal suctioning related pain and its influencing factors in postoperative patients with mechanical ventilation. Chin J Nurs 2018;53:537‑42.

Özden D, Görgülü RS. Effects of open and closed suction systems on the haemodynamic parameters in cardiac surgery patients. Nurs Crit Care 2015;20:118‑25.

Haghighat S, Yazdannik A. The practice of intensive care nurses using the closed suctioning system: An observational study. Iran J Nurs Midwifery Res 2015;20:619‑25.

Baarslag MA, Jhingoer S, Ista E, Allegaert KM, Tibboel D, van Dijk M. How often do we perform painful and stressful procedures in the PICU? A prospective observational study. Aust Crit Care 2019;32:4‑10.

Chegondi M, Francis T, Lin W‑C, Naqvi S, Raszynski A, Totapally BR. Effects of closed endotracheal suctioning on systemic and cerebral oxygenation and hemodynamics in children. Pediatr Crit Care Med 2018;19:23‑30.

Aryani DF, Tanner J. Does open or closed endotracheal suction affect the incidence of ventilator associated pneumonia in the intensive care unit? A systematic review. Enferm Clin 2018;28:325‑31.

Fisk AC. The effects of endotracheal suctioning in the pediatric population: An integrative review. Dimens Crit Care Nurs 2018;37:44‑56.

Evans J, Syddall S, Butt W, Kinney S. Comparison of open and closed suction on safety, efficacy and nursing time in a paediatric intensive care unit. Aust Crit Care 2014;27:70‑4.

Rijkenberg S, Stilma W, Endeman H, Bosman R, Oudemans‑van Straaten H. Pain measurement in mechanically ventilated critically ill patients: Behavioral pain scale versus critical‑care pain observation tool. J Crit Care 2015;30:167‑72.

Parrinder P. Science Fiction: A Critical Guide. Routledge; 2014.

Kanji S, MacPhee H, Singh A, Johanson C, Fairbairn J, Lloyd T, et al. Validation of the critical care pain observation tool in critically ill patients with delirium: A prospective cohort study. Crit Care Med 2016;44:943‑7.

Liu Y, Li L, Herr K. Evaluation of two observational pain assessment tools in Chinese critically ill patients. Pain Med 2015;16:1622‑8.

Dastdadeh R, Ebadi A, Vahedian‑Azimi A. Comparison of the effect of open and closed endotracheal suctioning methods on pain and agitation in medical ICU patients: A clinical trial. Anesth Pain Med 2016;6:e38337 .

Hall JE. Pocket Companion to Guyton & Hall Textbook of Medical Physiology E‑Book. Elsevier Health Sciences; 2015.

Mohammadpour A, Amini S, Shakeri MT, Mirzaei S. Comparing the effect of open and closed endotracheal suctioning on pain and oxygenation in post CABG patients under mechanical ventilation. Iran J Nurs Midwifery Res 2015;20:195‑9.

Acikgoz A, Yildiz S. Effects of open and closed suctioning systems on pain in newborns treated with mechanical ventilation. Pain Manag Nurs 2015;16:653‑63.

Corley A, Spooner AJ, Barnett AG, Caruana LR, Hammond NE, Fraser JF. End‑expiratory lung volume recovers more slowly after closed endotracheal suctioning than after open suctioning: A randomized crossover study. J Crit Care 2012;27:742.e1‑7.


Refbacks

  • There are currently no refbacks.