Background: Airway suctioning is a procedure routinely used in patients requiring artificial airways and mechanical ventilation, which involves introducing a sterile flexible tube through the airway and applying sub-atmospheric pressure upon its removal to remove secretions. This practice allows for the removal of secretions in individuals who are unable to properly remove them on their own; however, it is not without a whole host of adverse effects, which is why it should be performed with indication and caution. Currently, evidence on the actual risks and benefits of this procedure is lacking, and further studies are needed in order to create standardized policies for safe and effective care. Lung ultrasound is a point-of-care technique that is easy to learn, radiation-free, at the patient's bedside, rapid and repeatable. This has proven to be an extremely effective method in the neonatal setting in assessing, both qualitatively and also functionally, various respiratory disorders, with the advantage of being non-invasive examination and simple to perform. Purposes: This study aims to evaluate how the patient's pulmonary ultrasound appearance varies following the airway suction procedure, both immediately and after some time, using Brat's score. Methodology: This is a pilot prospective observational study that included 12 premature infants in the Neonatal Intensive Care Unit (NICU) and Neonatal Pathology of the Hospital of Padua who required respiratory support, both invasive and non-invasive, undergoing the airway aspiration procedure as routine. Patients included in the study were subjected to lung ultrasonography at three timepoints: before airway suction, after airway suction, and 1 hour after airway suction. The lung ultrasound image was evaluated according to Brat's score, assigning each lung area (6 for classic LUS score and 10 for extended LUS, eLUS) a score from 0 to 3. Anamnestic, clinical, and physiological parameters were collected and recorded for each patient. Discussion: Airway clearance results in a significant difference on the pulmonary ultrasound image when assessed by extended LUS, which also includes posterior areas, but not when classical LUS is considered. In contrast, no significant difference is found between the post aspiration and the image one hour after aspiration. There was a significant correlation of LUS and eLUS with oxygenation indices, SpO2/FiO2 and respiratory index, in the three timepoints. Conclusions: Ultrasound is a valuable tool for assessing the evolution of the lung image following the airway suction maneuver. Aspiration produces a heterogeneous pattern of ventilation distribution, which tends to be greater in the posterior areas. The improvement in the lung picture persists for at least one hour after suctioning is performed. The patients who benefit most from the procedure are those with a worse starting LUS. Further research is needed to establish standardized protocols to make the most effective use of the airway suction procedure in infants.
Background: L’aspirazione delle vie aeree è una procedura utilizzata di routine nei pazienti che necessitano di vie aeree artificiali e di ventilazione meccanica, che consiste nell’introdurre un tubo flessibile sterile attraverso le vie aeree e nell’applicare una pressione sub-atmosferica al momento della sua rimozione per aspirare le secrezioni. Questa pratica consente la rimozione delle secrezioni in soggetti che non sono in grado di rimuoverle correttamente in autonomia, tuttavia non è esente da tutta una serie di effetti avversi, motivo per cui dovrebbe essere eseguita con indicazione e cautela. Ad oggi mancano evidenze sugli effettivi rischi e benefici di questa procedura e sono necessari ulteriori studi al fine di creare politiche standardizzate per un’assistenza sicura ed efficace. L’ecografia polmonare è una tecnica point-of-care, facile da apprendere, priva di radiazioni, al letto del paziente, rapida e ripetibile. Questa ha dimostrato di essere una metodica estremamente efficace in ambito neonatale nel valutare, sia in modo qualitativo che più funzionale, diversi disturbi respiratori, con il vantaggio di essere un esame non invasivo e semplice da eseguire. Obiettivi: Questo studio mira a valutare come varia l’aspetto ecografico polmonare del paziente a seguito della procedura di aspirazione delle vie aeree, sia nell’immediato che a distanza, utilizzando lo score di Brat. Materiali e metodi: Si tratta di uno studio pilota osservazionale prospettico che ha incluso 12 neonati prematuri del reparto di Terapia Intensiva Neonatale (TIN) e Patologia Neonatale dell’Azienda Ospedaliera di Padova che necessitavano di supporto respiratorio, sia invasivo che non, sottoposti, come da routine, alla procedura di aspirazione delle vie aeree. I pazienti inclusi nello studio sono stati sottoposti ad ecografia polmonare in tre momenti distinti: prima dell’aspirazione delle vie aeree, dopo l’aspirazione delle vie aeree e 1 ora dopo l’aspirazione delle vie aeree. Il quadro ecografico polmonare è stato valutato secondo lo score di Brat, assegnando ad ogni zona polmonare (6 per il LUS score classico e 10 per quello esteso, eLUS) un punteggio da 0 a 3. Per ogni paziente sono stati inoltre raccolti e registrati parametri anamnestici, clinici e fisiologici. Risultati: La liberazione delle vie aeree determina una differenza significativa sul quadro ecografico polmonare se valutato mediante punteggio LUS esteso, che include anche le aree posteriori, ma non se si considera il LUS classico. Nessuna differenza significativa si riscontra invece tra il post-aspirazione e il quadro ad un’ora dall’aspirazione. Si è riscontrata una correlazione significativa del LUS e dell’eLUS con gli indici di ossigenazione, SpO2/FiO2 e l’indice respiratorio, nei tre timepoints. Conclusioni: L’ecografia è uno strumento valido per valutare l’evoluzione del quadro polmonare a seguito della manovra di aspirazione delle vie aeree. L’aspirazione produce un pattern eterogeneo di distribuzione della ventilazione, che tende ad essere maggiore nelle aree posteriori. Il miglioramento del quadro polmonare permane per almeno un’ora dopo l’esecuzione dell’aspirazione. I pazienti che beneficiano maggiormente della procedura sono quelli con un quadro polmonare di partenza peggiore. Sono necessarie ulteriori ricerche per definire protocolli standardizzati che consentano di sfruttare nel modo più efficace la procedura di aspirazione delle vie aeree nei neonati.
Influenza dell’aspirazione delle vie aeree sullo score ecografico polmonare in neonatologia
REA, FLAVIA
2023/2024
Abstract
Background: Airway suctioning is a procedure routinely used in patients requiring artificial airways and mechanical ventilation, which involves introducing a sterile flexible tube through the airway and applying sub-atmospheric pressure upon its removal to remove secretions. This practice allows for the removal of secretions in individuals who are unable to properly remove them on their own; however, it is not without a whole host of adverse effects, which is why it should be performed with indication and caution. Currently, evidence on the actual risks and benefits of this procedure is lacking, and further studies are needed in order to create standardized policies for safe and effective care. Lung ultrasound is a point-of-care technique that is easy to learn, radiation-free, at the patient's bedside, rapid and repeatable. This has proven to be an extremely effective method in the neonatal setting in assessing, both qualitatively and also functionally, various respiratory disorders, with the advantage of being non-invasive examination and simple to perform. Purposes: This study aims to evaluate how the patient's pulmonary ultrasound appearance varies following the airway suction procedure, both immediately and after some time, using Brat's score. Methodology: This is a pilot prospective observational study that included 12 premature infants in the Neonatal Intensive Care Unit (NICU) and Neonatal Pathology of the Hospital of Padua who required respiratory support, both invasive and non-invasive, undergoing the airway aspiration procedure as routine. Patients included in the study were subjected to lung ultrasonography at three timepoints: before airway suction, after airway suction, and 1 hour after airway suction. The lung ultrasound image was evaluated according to Brat's score, assigning each lung area (6 for classic LUS score and 10 for extended LUS, eLUS) a score from 0 to 3. Anamnestic, clinical, and physiological parameters were collected and recorded for each patient. Discussion: Airway clearance results in a significant difference on the pulmonary ultrasound image when assessed by extended LUS, which also includes posterior areas, but not when classical LUS is considered. In contrast, no significant difference is found between the post aspiration and the image one hour after aspiration. There was a significant correlation of LUS and eLUS with oxygenation indices, SpO2/FiO2 and respiratory index, in the three timepoints. Conclusions: Ultrasound is a valuable tool for assessing the evolution of the lung image following the airway suction maneuver. Aspiration produces a heterogeneous pattern of ventilation distribution, which tends to be greater in the posterior areas. The improvement in the lung picture persists for at least one hour after suctioning is performed. The patients who benefit most from the procedure are those with a worse starting LUS. Further research is needed to establish standardized protocols to make the most effective use of the airway suction procedure in infants.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/63126