Closed versus open endotracheal suctioning in preterm infants: effects on cerebral oxygenation and blood volume. Maternal hyperoxygenation in the treatment of intrauterine growth retardation. Closed suctioning system reduces cross-contamination between bronchial system and gastric juices. Pain relief can reduce hypoxemia in distressed neonates during routine treatment procedures. A prospective, randomized evaluation of intrapartum amnioinfusion. Fetal acid-base status and cesarean delivery. Tracheal suction in meconium stained infants: a randomized controlled study. Closed versus open endotracheal suctioning: costs and physiologic consequences. A double-blind, randomized controlled trial on the use of a 50:50 mixture of nitrous oxide/oxygen in pain relief during suction evacuation for the first trimester pregnancy termination. [Is oxygen therapy truly useful and necessary during elective cesarean section under spinal anesthesia?].
The aim of our study was to compare, using near-infrared spectroscopy (NIRS), the effects on cerebral intracellular oxygenation and cerebral blood volume (CBV) of closed endotracheal suctioning (CS), which permits continuous ventilation of the patient, with open endotracheal suctioning (OS), which requires disconnection from the ventilator. Eleven preterm infants were studied. Each patient underwent one CS, followed, after 60 min, by one OS, or vice versa, three times during the same day. Modifications in CBV and oxidized cytochrome oxidase (CytO2) were continuously detected by NIRS; arterial oxygen saturation (SaO2) heart rate (HR), transcutaneous carbon dioxide tension and mean arterial blood pressure were simultaneously recorded. Significant reductions in HR and SaO2 were observed following OS; the magnitude and duration of these negative effects of suctioning were significantly reduced with CS. In addition, the decrease in CBV was more pronounced than following CS. No changes in CytO2 concentration were seen. In the current study the efficacy of maternal hyperoxygenation on growth-retarded fetuses was evaluated.
                Thirty-six pregnant women with intrauterine growth retardation were studied. The patients were divided in oxygen-treated (n = 17) and untreated (n = 19) groups. Doppler analysis of the fetal circulation was performed on the arrival to the hospital, after 12 hours, and thereafter on alternate days until delivery. Fetal blood was sampled by cordocentesis for immediate blood gas analysis at entrance to the study and the day of delivery.
                Significant improvement in Doppler flow patterns in treated patients were found when compared with untreated women. The Doppler variations were associated with complementary modifications in fetal blood gas. These differences resulted in a significant modification in perinatal mortality with an incidence of 29% and 68% (p less than 0.01) in treated and untreated groups, respectively.
                Our data suggest a benefit of maternal hyperoxygenation in the treatment of fetal growth retardation. In this prospective, randomized study, we evaluated whether a closed suctioning (CS) system (TrachCare) influences crossover contamination between bronchial system and gastric juices when compared with an open suctioning system (OS). The secondary aims were an analysis of the frequency of ventilator-associated pneumonia (VAP) and an analysis of alteration in gas exchange. Antibiograms were performed from tracheal secretions and gastric juice aspirates on Days 1 and 3 of intubation in 24 patients in a medical intensive care unit. Five cross-contaminations were observed in the OS group on Day 3 versus Day 1; the 5 strains shared common genotypes as determined by random amplification of polymorphic DNA. No cross-contaminations were seen in the CS group (P = 0.037). VAP occurred in 5 patients of the OS group but in none of the CS group patients (P = 0.037). Spao(2) decreased significantly in the OS group compared with presuctioning values--the opposite of the CS group. Whereas presuctioning values were comparable between groups, postsuctioning Spao(2) was significantly higher in the CS group. CS significantly reduced cross-contamination between bronchial system and gastric juices and reduced the incidence of VAP when compared with OS. Hypoxic phases can be reduced by the help of CS. To determine whether the use of opioids could reduce the hypoxemia and hemodynamic instability associated with routine intensive care procedures in neonates with respiratory distress.
                Randomized and placebo-controlled study.
                Physiological, plasma beta-endorphin, cortisol, and glucose responses to routine treatment procedures were studied in 84 mechanically ventilated distressed neonates randomized into groups receiving 1 mg/kg meperidine or 0.9% saline 15 minutes before tracheal suction or routine nursing care.
                The duration of hypoxemia (transcutaneous partial pressure of O2 < 6.6 kPa (< 50 mm Hg) and/or arterial blood oxygen saturation < 80%) during treatment procedures was significantly longer in the saline group (mean 82 vs 36 seconds, P = .001) and distress quantified by a novel behavioral scoring method was much higher. Changes in arterial blood pressure, heart rate, or plasma beta-endorphin, cortisol, and glucose concentration did not show any statistically significant differences between the groups.
                Newborns with respiratory difficulties often suffer from hypoxemia during essential treatment procedures. The use of opioid analgesia may reduce the duration of hypoxemia and the associated distress and, therefore, may improve the long-term results of neonatal intensive care. Pregnancies with decreased amniotic fluid volume are prediposed to umbilical cord compression and variable fetal heart rate declerations. Intrapartum amnioinfusion has been utilized in an effort to reduce cord compression. Previous studies suggested that amnioinfusion may improve the fetal metabolic state and reduce the incidence of cesarean delivery in selected patients. In this study the hypothesis was tested that intrapartum amnioinfusion will relieve cord compression in pregnancies complicated by oligohydramnios and will result in a reduced incidence of fetal intolerance to labor as well as improved fetal acid-base status at delivery. Thirty-five patients fulfilling the inclusion criteria were randomized to either the control (n = 16) or amnioinfusion treatment group (n = 19). Analysis of the data suggested that the two groups were similar for the perinatal parameters evaluated. No differences were observed in the umbilical artery blood gas analysis or incidence of cesarean section between the two groups. Intrapartum amnioinfusion does not appear to improve the perinatal outcome in pregnancies with oligohydramnios. We performed a randomized controlled study of the mortality and morbidity of 49 babies born with thick meconium staining of amniotic fluid. These unasphyxiated babies were consecutively born and were admitted to the intensive care unit for observation as routine. The groups were comparable in regard to sex, birth weight, gestational age, maternal factors like anaemia, toxaemia, antepartum haemorrhage, prolonged rupture of membranes, presentation, and interventions including caesarian section. The control group, comprising 26 babies received only oropharyngeal suction, while the intervention group, comprising 23 babies, underwent oropharyngeal suction followed by tracheal suction. There was no significant difference in the mortality or morbidity in form of evidence of air leak or hypoxic ischaemic encephalopathy. To examine the physiologic consequences and costs associated with two methods of endotracheal suctioning: closed vs. open.
                A prospective, randomized, controlled study.
                An eight-bed trauma intensive care unit (ICU) in a 460-bed level I trauma center.
                The study included 35 trauma/general surgery patients (16 in the open suction group, 19 in the closed suction group) who were treated with a total of 276 suctioning procedures (127 open, 149 closed).
                Physiologic data collected after hyperoxygenation, immediately after suctioning, and 30 secs after suctioning, were compared with baseline values. Open endotracheal suctioning resulted in significant increases in mean arterial pressure throughout the suctioning procedure. Both methods resulted in increased mean heart rates. However, 30 secs after the procedure, the open-suction method was associated with a significantly higher mean heart rate than was the closed method. Closed suctioning was associated with significantly fewer dysrhythmias. Arterial oxygen saturation and systemic venous oxygen saturation decreased with open suctioning. In contrast, arterial oxygen saturation and systemic venous oxygen saturation increased with the closed suction method. There was no difference between the two methods in the occurrence of nosocomial pneumonia. Open endotracheal suctioning cost $1.88 more per patient per day and required more nursing time.
                The closed suction method resulted in significantly fewer physiologic disturbances. Closed suctioning appears to be an effective and cost-efficient method of endotracheal suctioning that is associated with fewer suction-induced complications. This prospective study assessed the role of a 50:50 mixture of nitrous oxide (N2O) and oxygen for pain relief during the termination of first trimester pregnancies by suction evacuation under conscious sedation.
                Ninety women undergoing suction evacuation up to 12 weeks of gestation were randomized by a computer-generated randomization list and allocated using sealed envelopes to receive the N2O/O2 mixture or air during the operation. Pain scores during and after suction evacuation, post-operative side effects and satisfaction level were compared.
                No statistically significant differences in pain scores, post-operative side effects and satisfaction levels were found between the two groups.
                N2O/O2 did not reduce the pain level during suction evacuation for the first trimester pregnancy termination under conscious sedation. To analyze maternal and fetal well-being with and without the application of oxygen therapy.
                Randomized trial of full-term parturients who had received prenatal care during pregnancy. The women were healthy and classified as ASA 1. They were scheduled for delivery by cesarean section under spinal anesthesia and randomized to 2 groups to breathe room air or air providing an inspired oxygen fraction of 40% through a face mask. We assessed the well-being of the neonate immediately after birth with the Apgar test and by measuring umbilical cord blood gases.
                One hundred thirty women were enrolled. Both groups were similar, with no differences in demographic or hemodynamic variables, time from uterine incision to fetal extraction, neonatal birth weight, presence of umbilical cord abnormalities, type of resuscitation required by the neonate, or Apgar score in the first or fifth minute. Oxygen saturation in maternal blood by pulse oximetry was higher after 10 minutes in the group of women who received supplemental oxygen through face masks. We also observed significant differences in umbilical cord arterial blood between the room air and supplemental oxygen groups, respectively, as follows: PaCO2, 51.14 mm Hg vs 54.33 mm Hg (P=.016); bicarbonate, 22.19 mEq L(-1) vs 23.23 mEq L(-1) (P=.012); lactate, 1.85 mmol L(-1) vs 1.64 mmol L(-1) (P=.038). The PO2 in venous blood also differed significantly: 25.53 mm Hg vs 28.13 mm Hg, respectively (P=033).
                Breathing supplemental oxygen or not during elective cesarean delivery of healthy parturients under spinal anesthesia does not have a significant effect on neonatal well-being.
This review does not provide sufficient evidence on which to base practice. Although preoxygenation was shown to decrease hypoxemia at the time of suctioning, this result comes from only one small poor quality trial in which other clinically important outcomes were not assessed. Further studies are needed.