Research has shown that timely suctioning not only improves survival rates but also enhances the quality of life in ventilator-dependent patients. However, clinical judgment on the optimal timing for suctioning currently relies primarily on physician experience, lacking scientific evidence \[10\]. Airway viscous resistance reflects the frictional resistance encountered by gas flow within the airways and is closely associated with airway patency. When airway secretions increase, viscous resistance undergoes dynamic changes. Therefore, analyzing these dynamic variations in viscous resistance derived from ventilator waveforms to determine the optimal suctioning timing and assess its clinical impact on the progression of pulmonary inflammation holds significant scientific value and offers new insights and methodologies for clinical practice.
Clinical diagnosis of Acute Respiratory Distress Syndrome (ARDS)
Clinical diagnosis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)
Clinical diagnosis of Severe pneumonia
Clinical diagnosis of multiple organ failure;
Clinical diagnosis of multiple organ bleeding;
Crossover
The dynamics of airway resistance
Procedure/SurgeryMonitoring the dynamic changes in airway resistance in patients can be used to reflect the progression of pulmonary inflammation and determine the optimal timing for suctioning.
conventional suctioning
Diagnostic testThe timing for suctioning is determined based on clinical signs such as rhonchi and an elevated peak pressure.
The drop in airway viscous resistance before and after sputum suction
Airway viscous resistance drop (AVRD) is the primary efficacy endpoint of this study. It is defined as the difference in airway viscous resistance measured immediately before and after suctioning. Procedure: Record the ventilator-displayed viscous resistance value pre-suction; immediately after the maneuver, re-measure both viscous resistance and peak airway pressure with a high-precision pressure-time sensor. Calculation: The within-patient difference (pre minus post) is the AVRD. In a pilot study of nine patients, AVRD averaged 6.889 ± 3.551 cmH₂O, significantly larger than the concurrent peak-pressure drop (1.556 ± 1.740 cmH₂O), indicating that AVRD is more sensitive to the effect of suction on airway secretions. Clinical implication: AVRD can serve as a quantitative criterion for determining the optimal timing of endotracheal suction.
The number of participants with abnormal laboratory tests
Venous blood testing was performed, including a complete blood count (white blood cell count \[WBC\], neutrophil percentage \[NEUT%\]), C-reactive protein (CRP), and procalcitonin (PCT) to assess the systemic inflammatory status.
Sputum bacterial culture
Sputum culture is performed to identify the source of infection and to diagnose VAP.
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