OBJECTIVES: To compare change in lung volume (deltaVL), using respiratory inductive plethysmography, time to recover pre-suction lung volume (t-rec) and the cardiorespiratory disturbances associated with open suction (OS) and closed suction (CS) in ventilated infants. DESIGN: Randomised blinded crossover trial. SETTING: Neonatal intensive care unit. PATIENTS: Thirty neonates, 20 receiving synchronised intermittent mandatory ventilation (SIMV) and 10 high-frequency oscillatory ventilation (HFOV, four receiving muscle relaxant). INTERVENTIONS: OS and CS were performed, in random order, on each infant using a 6FG catheter at -19 kPa for 6 seconds and repeated after 1 minute. OUTCOME MEASURES: DeltaVL, oxygen saturation (SpO2) and heart rate were continuously recorded from 2 minutes before until 5 minutes after suction. Lowest values were identified during the 60 seconds after suction. RESULTS: Variations in all measures were seen during CS and OS. During SIMV no differences were found between OS and CS for maximum deltaVL or t-rec; mean (95% CI) difference of 3.5 ml/kg (-2.8 to 9.7) and 4 seconds (-5 to 13), respectively. During HFOV t-rec was longer during OS by 13 seconds (0 to 27) but there was no difference in the maximum deltaVL of 0.1 mV (-0.02 to 0.22). A small reduction in SpO2 with CS in the SIMV group mean difference 6% (2.1 to 9.8) was the only significant difference in physiological measurements. CONCLUSIONS: Both OS and CS produced transient variable reductions in heart rate and SpO2. During SIMV there was no difference between OS and CS in deltaVL or t-rec. During HFOV there was no difference in deltaVL but a slightly longer t-rec after OS.
Reproduced with permission from the BMJ Publishing Group.

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