Effect of Minimally Invasive Endotracheal Suctioning on Physiological Parameters Among Mechanically Ventilated Preterm.

Abstract

Background: A mechanical ventilator is a significant life-saving intervention for pretermneonates. Thus, those neonates need recurrent endotracheal suctioning to remove pulmonarysecretions. However, it is necessary, as it is a noxious stimulus, and physiological changes can beobserved during this procedure. Therefore, critical neonatal nurses have a crucial role duringendotracheal suctioning with minimal negative side effects. Aim of the study: to evaluate theimpact of minimally invasive endotracheal suctioning on physiological parameters amongmechanically ventilated preterm. Design: A quasi-experimental research design was used.Settings: This study was conducted at the Neonatal Intensive Care Unit at Alexandria UniversityChildren's Hospital at El-Shatby. Subjects and Method: A convenient sample of 60mechanically ventilated preterm neonates who were admitted to the previously mentionedsettings (25 neonates from were fulfilled the following criteria; mechanically ventilated pretermneonates on invasive endotracheal tube, gestational age less than 37 weeks at birth and notreceiving any sedatives. Those neonates were distributed equally into control and study groups(30 neonates in each one). Preterm neonates in the control group experienced routineendotracheal suctioning in the unit (deep suctioning) by the assigned neonatal nurse. In contrast,those in the study group experienced minimally invasive endotracheal suctioning by theresearcher. Physiological parameters of neonates were assessed before, during, immediately, afterthree and ten minutes of the procedure. Results: it was found that more than three-quarters ofpreterm neonates (76.7%) in the study group had normal heart rate immediately after suctioning,compared to most of the neonates in the control group (96.7%) who still recorded tachycardia(p<0.001). A statistically significant difference between both groups of the study was foundimmediately after and after three minutes of suctioning concerning respiratory rate (p<0.001),whereas around two-thirds of neonates in the study had normal respiratory rate, but almost all ofthe neonates in the control group recorded tachypnea (p<0.001). Regarding oxygen saturationduring suctioning, the means of oxygen saturation were 88.4±7.0% and 90.0±3.6% in the controland study groups, respectively. A statistically significant difference was found between bothgroups of study (p=0.001). Conclusion: This study demonstrates that minimally invasiveendotracheal suctioning in intubated preterm neonates had less effect on physiological parameteralterations than routine deep endotracheal suctioning. Recommendations: The followingrecommendations are suggested: The critical neonatal nurse must assess the need of neonates forsuctioning and monitor the preterm infant during and after the procedure. Additionally, thosenurses need to practice minimal invasive endotracheal suctioning for preterm neonates to aviodpotential outcomes.