PURPOSE:Secretions in patients intubated on positive pressure ventilation are common. Suctioning can be overused or underused, leading to tracheobronchial wall trauma or atelectasis. Secretions can be detected by auscultation with a stethoscope, visual detection while suctioning, increased airway resistance on ventilator parameters, and observing the expiratory graphic on flow-time wave and flow-volume loop. We hypothesize that the pigtail sign (see graphic) on flow pressure loops correlate with secretions and may be more sensitive than flow volume loops and auscultation.
METHODS:One hundred consecutive patients were randomly evaluated on ventilators. Drager-Evita II (Drager Company, California) ventilators were used in this study. All patients were intubated and had a variety of clinical disease states including chronic obstructive pulmonary disease, congestive heart failure, pneumonia, acute respiratory distress syndrome, and asthma. Flow pressure loops were evaluated before and after suctioning. Only flow pressure loops that had an initial pigtail sign were included in this study. After suctioning was performed with a closed system suction catheter, flow pressure wave form was reevaluated to assess whether the pigtail sign disappeared.
RESULTS:Seventy-four out of the 100 pigtails sign disappeared after suctioning was performed. The remaining 26 pigtails did not disappear. Repeat suctioning was performed and 14 out of the 26 pigtails disappeared.
CONCLUSION:This study showed that the pigtail sign is a good indicator for secretions. Pigtail signs can be more specific than auscultation. Also evaluating graphics decreases the risk of transmitting infection when compared to auscultation with a conventional stethoscope because no direct contact of patient is needed. They also may guide more appropriate suction timing.
CLINICAL IMPLICATIONS:Flow pressure loop can be used to assess the amount of secretions in the intubated patient.
DISCLOSURE:Rohit Goyal, No Financial Disclosure Information; No Product/Research Disclosure Information