Thesis & Dissertations

Tracheal suctioning (TS) is periodically warranted in mechanically ventilated patients to maintain airway patency, and clear secretions. Hypoxemia is considered as the most common and serious complication of TS. This study was conducted to determine the effect of Manual Resuscitation Bag (MRB) versus mechanical hyperoxygenation on the incidence of suctioning associated hypoxemia, in critically mechanically ventilated patients. This study was conducted at the Critical Care Units (CCUs) of Rafic Hariri University Hospital (RHUH), Beirut, Lebanon. It included 60 mechanically ventilated patients. One tool was developed and used to collect necessary data; "Suctioning related physiological response assessment sheet". It included two parts: part (1) hemodynamic response parameters including, heart rate, systolic and diastolic blood pressure, mean arterial blood pressure, and presence of cardiac dysrhythmias. Part (2) respiratory response parameters, included arterial blood gases parameters, in addition to hypoxemic index, alveolar gradient (A-a gradient), respiratory rate, peak airway pressure and cough reflex. When comparing between both suctioning methods, it was found that heart rate (HR) elevated 5 minutes after TS using mechanical ventilator (MV) method. The pH decreased significantly five minutes after TS using MRB method; however this drop was not clinically significant to cause fatal complications. Oxygen index became better after TS using MRB method, but it worsened using MV method. A-a gradient worsened immediately after TS using MRB method, yet by using MV, it became better after TS by five minutes. Thus, MRB method is little bit better than MV for hyper-oxygenation in patients with normal lung, which would be fatal in patients with poor lung compliance i.e. Acute Respiratory Distress Syndrome (ARDS), requiring high positive end expiratory pressure (PEEP), and are already on Fraction of Inspired Oxygen (FiO2) 100% before TS.