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Effects of Endotracheal Tube Suctioning on Arterial Oxygen Tension and Heart Rate Variability

annette64{at}tricolour.queensu.ca

C. Ann Brown, RN, PhD

School of Nursing in the Faculty of Health Sciences at Queen’s University, Kingston, ON, Canada

Sylvia M. J. Hains, PhD

Joel L. Parlow, MD, MSc

Department of Anaesthesiology at Kingston General Hospital, Kingston, ON, Canada, Department of Pharmacology and Toxicology at Queen’s University, Kingston, ON, Canada

The purpose of this study was to examine the autonomic mechanisms underlying changes in heart rate (HR) and systolic blood pressure (SBP) responses to endotracheal tube (ETT) suctioning and to compare the open versus closed methods of ETT suctioning on these measures and on arterial oxygen tension. Eighteen orally intubated participants, 33 to 82 years of age (M = 60 years), were randomized for the order of suctioning method. Arterial oxygen tension (PaO₂) was measured before suctioning and 30 s and 5 min following suctioning. Beat-to-beat HR and arterial blood pressure data were collected for 10-min periods before and after suctioning. HR and SBP measures were analyzed before suctioning and 1 min and 5 min following suctioning. Although there were no significant effects of ETT suctioning on the autonomic mechanisms of HR modulation and no significant differences between the two methods of suctioning, ETT suctioning resulted in an increase in HR, SBP, and PaO₂. However, there was a decrease in the parasympathetic nervous system indicator of HR variability (HRV) following open suctioning. All patients in this study maintained a PaO₂ level 80 mm Hg, which may account for our lack of significant autonomic changes. This suggests that hyperoxygenation with 100% oxygen for a minimum of 1 min (or 20 breaths), as delivered by preoxygenation modes available on most microprocessor ventilators, should be the method of choice for all hyperoxygenation procedures to avoid a decrease in PaO₂ following suctioning.

Key Words: heart rate variability • arterial oxygen tension • blood pressure • suctioning • critical care • autonomic • endotracheal • positive pressure ventilation

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