BACKGROUND: Endotracheal suctioning causes discomfort, is associated with adverse effects and is resource demanding. An artificial secretion removal method, known as an automated cough, has been developed, applying rapid, automated deflation and inflation of the endotracheal tube cuff during the inspiratory phase of mechanical ventilation. This method has been evaluated in the hands of researchers but not when used by attending nurses. The aim of this study was to explore the efficacy of the method over the course of patient management as part of routine care. METHODS: This prospective, longitudinal, interventional study recruited 28 subjects who were intubated and mechanically ventilated. For a maximum of 7 days and on clinical need for endotracheal suctioning, the automatic cough procedure was applied. Subjects were placed in a pressure regulated ventilation mode with elevated inspiratory pressure, and automated cuff deflation and inflation was performed 3 times, with this repeated if deemed necessary. Success was determined by removal of the clinical need for suctioning as determined by the attending nurse. Adverse effects were recorded. RESULTS: A total of 84 procedures were performed. In 54% of subjects the artificial cough procedure was successful on more than 70% of occasions, with 56% of all procedures considered successful. Ninety percent of all procedures were performed in spontaneously breathing subjects on pressure support ventilation with peak inspiratory pressures of 20 cmH₂O. Rates of adverse events were similar to those seen in application of endotracheal suctioning. CONCLUSIONS: This study solely evaluated efficacy of an automated artificial cough procedure, illustrating the potential for reducing the need for endotracheal suctioning when applied by attending nurses in routine care.

中文翻译：

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一项评估自动分泌物去除技术功效的前瞻性纵向研究。


背景：气管内抽吸会引起不适、产生不良反应并且需要资源。一种被称为自动咳嗽的人工分泌物清除方法已经被开发出来，该方法在机械通气的吸气阶段对气管导管套囊进行快速、自动的放气和充气。该方法已在研究人员手中进行了评估，但未由主治护士使用。本研究的目的是探讨该方法在作为常规护理一部分的患者管理过程中的有效性。方法：这项前瞻性、纵向、介入性研究招募了 28 名接受插管和机械通气的受试者。最多 7 天，并且根据临床需要进行气管内抽吸，应用自动咳嗽程序。将受试者置于吸气压力升高的压力调节通气模式，并进行自动袖带放气和充气3次，如果认为有必要则重复该操作。成功取决于主治护士确定的临床抽吸需求的消除。记录了不良反应。结果：总共进行了 84 例手术。在 54% 的受试者中，人工咳嗽手术成功率超过 70%，其中 56% 的手术被认为是成功的。 90% 的手术均在自主呼吸受试者中进行，压力支持通气的吸气峰值压力为 20 cmH ₂ O。不良事件发生率与气管内抽吸应用中所见的不良事件发生率相似。 结论：这项研究仅评估了自动人工咳嗽程序的功效，表明主治护士在日常护理中应用时可以减少气管内抽吸的需要。