A Prospective, Longitudinal Study Evaluating the Efficacy of an Automated Secretion Removal Technology

BACKGROUND: Endotracheal suctioning causes discomfort, is associated with adverse effects and is resource demanding. An artificial secretion removal method, known as an automated cough, has been developed, applying rapid, automated deflation and inflation of the endotracheal tube cuff during the inspiratory phase of mechanical ventilation. This method has been evaluated in the hands of researchers but not when used by attending nurses. The aim of this study was to explore the efficacy of the method over the course of patient management as part of routine care. METHODS: This prospective, longitudinal, interventional study recruited 28 subjects who were intubated and mechanically ventilated. For a maximum of 7 days and on clinical need for endotracheal suctioning, the automatic cough procedure was applied. Subjects were placed in a pressure regulated ventilation mode with elevated inspiratory pressure, and automated cuff deflation and inflation was performed 3 times, with this repeated if deemed necessary. Success was determined by removal of the clinical need for suctioning as determined by the attending nurse. Adverse effects were recorded. RESULTS: A total of 84 procedures were performed. In 54% of subjects the artificial cough procedure was successful on more than 70% of occasions, with 56% of all procedures considered successful. Ninety percent of all procedures were performed in spontaneously breathing subjects on pressure support ventilation with peak inspiratory pressures of 20 cmH₂O. Rates of adverse events were similar to those seen in application of endotracheal suctioning. CONCLUSIONS: This study solely evaluated efficacy of an automated artificial cough procedure, illustrating the potential for reducing the need for endotracheal suctioning when applied by attending nurses in routine care.