BACKGROUND: The harmful effects of mechanical ventilation and suctioning are compounded if endotracheal suctioning (ETS) is inappropriately performed. Deep ETS involves catheter insertion into the endotracheal tube until resistance is met. Shallow ETS may be beneficial in lessening mechanical irritation to the first bronchial layers. However, clinical observation reveals wide variation in the length of the suction catheter for ETS in highrisk infants. OBJECTIVE: The study was conducted to examine the effects of deep and shallow ETS on the cytological components of respiratory aspirates from high-risk infants. METHODS: A cross-over experimental study was performed in 22 high-risk infants with a mean birth weight of 2,200 g. Whether deep or shallow ETS was conducted first was determined randomly. The numbers of (1) columnar cells CC ciliated (CCC) and nonciliated (NCC), (2) fresh clustered columnar cells (CLCC), and (3) Curschmanns spirals (CS), a mucus cast residing inside the lower terminal airways, in the respiratory aspirates were compared between the two ETS protocols. RESULTS: No statistical differences were found in the quantities of CC, CLCC and NCC between shallow and deep ETS. However, greater quantities of CLCC were observed in the deep ETS aspirates than in the shallow ETS aspirates. CONCLUSIONS: Detachment of larger amounts of clustered columnar cells from the respiratory epithelium without the guarantee that lung secretions from the lower airways will be removed questions the justification of deep ETS in high-risk infants.

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