The overall objective of this study is to contribute to the research basis of clinical nursing respiratory procedures in intubated hospitalized adults. An important aspect of the nursing care of these patients includes endotracheal suctioning. A major complication of suctioning these patients is the occurrence of hypoxemia. This complication is influenced by the duration of suctioning, the magnitude of suction pressure, the catheter size, patient variables, and the use of oxygen. The technique of hyperinflation prior to and after suctioning is used to reduce potential hypoxemia. Hyperinflation can be delivered (1) by removing the patient from the ventilator and using a resuscitation bag to give deep breaths or by (2) using the 'sigh' mechanism on the ventilator control panel to deliver the breaths. Each of these techniques has been supported by clinical studies; a comparison of these two techniques is needed. Thus the specific aim of the study is to compare the effects of hyperinflation via a ventilator versus a resuscitation bag on the level of hypoxemia in intubated adults, measured by oximeter monitoring. The study will be done with 72 consenting subjects undergoing non-thoracic surgical procedures, who are intubated, who are free of an acute pulmonary problem and do not require positive end expiratory pressure for maintenance of oxygenation. Patients are randomized to receive hyperinflation technique 1 followed by 2, or 2 followed by 1. The oxygen saturation values at baseline, preoxygenation, immediately post-suctioning, post-oxygenation, and five minutes post-oxygenation will be analyzed for a significant change in oxygen level using appropriate statistical tests. Completion of this study will contribute to establishment of a protocol for prevention of suction-induced hypoxemia.
