Evaluation of a New Balloon-Tipped Closed Suction System

Background: Mucus attached to the inner endotracheal tube (ETT) surface has the potential to increase airway resistance and patient work of breathing (WOB). Currently, blind suctioning through a small flexible catheter is the most common method to remove secretions from within the ETT. A new device incorporates an inflatable balloon that is designed to remove mucus by physically scraping the inner wall of the ETT (Cleansweep closed suction system, Teleflex Medical, Morrisville, NC), The aim of this bench study was to evaluate the impact of ETT scraping with this novel system on airway resistance. Methods: The balloon tipped suction system (BTSS) was compared to our standard suction system (Halyard, Alpharetta, Georgia). The systems were hooked up to a ventilator circuit and the ETT. The ventilator used was a Maquet Servo-i with the following settings: Volume assist control mode, VT 500 mL, RR 12/min, PEEP 5 cm H2O, Ti 0.8 s, T rise 0.40 (resulted in a constant flow of 50 L/min). The distal end of the ETT was connected to an Ingmar single chamber test lung with a resistance setting of 5 cm H2O/L/second and one spring attached. An upper airway model was used and the head was positioned at approximately 30 degrees. Three mL of artificial mucus was injected into the ETT and then the ventilator was connected at the above settings. Once the peak pressure stabilized (5-10 breaths) the peak pressure (Ppeak) and plateau pressure (Pplat) were recorded. Then suction was applied at — 120 mm Hg for 5 seconds. Readings were once again taken post suctioning. Five runs on each size ETT (7.0, 7.5 and 8.0) alternating between both suction systems with size 14 French catheters were carried out. Five additional runs on 7.0 ETT9s were made alternating between the suction systems with size 12 French catheters. Peak-plateau pressure decreases were recorded after using BTSS initially, BTSS following a standard suction, standard initially and standard following a BTSS suction. Each individual catheter was cleaned and reused one time. Results: Mean (± SD) cm H2O peak-plateau pressure changes are depicted in Table 1. All comparisons showed BTSS was significantly better than our standard system in reducing ventilator resistive pressures (P Conclusions: In this bench study the BTSS closed suction system was superior at reducing resistance through the various size ETT9s.