Effect of minimally invasive endotracheal tube suctioning on physiological indices in adult intubated patients: An open-labelled randomised controlled trial

Published:April 25, 2018DOI:



      Endotracheal tube suctioning (ETS) is one of the most frequent procedures performed by nurses in intensive care units. Nevertheless, some suctioning practices are still being performed that do not provide any benefit for patients.


      To investigate the effects of minimally invasive ETS (MIETS) versus routine ETS (RETS) on physiological indices in adult intubated patients.


      In this single centre parallel randomised controlled, open label trial, 64 adult intubated patients in the four intensive care units of Alzahra University hospital, Isfahan, Iran, were randomly allocated to a MIETS or a RETS group. Physiological indices including systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and peripheral oxygen saturation were assessed immediately before, immediately after, and 10 min after ETS in both groups. The chi-square test, independent t-test, and repeated measures analysis of variance were used to analyse the data.


      Sixty-four patients were randomised and analysed. There were no significant differences in mean heart rate between the both groups across the three time points. However, there was a significant drop in peripheral oxygen saturation across the three time points in the RETS group compared to the MIETS group. Furthermore, there was a significant increase in systolic blood pressure, diastolic blood pressure, and mean arterial pressure across the three time points in the RETS group compared to the MIETS group.


      The results of this study indicate that the use of MIETS has less effect on the alterations of physiological indices and consequently fewer adverse effects than RETS.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Australian Critical Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Van de Leur J.P.
        • Zwaveling J.H.
        • Loef B.G.
        • Van der Schans C.P.
        Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: a prospective randomised controlled trial.
        Intensive Care Med. 2003; 29: 426-432
        • Wang C.-H.
        • Tsai J.-C.
        • Chen S.-F.
        • Su C.-L.
        • Chen L.
        • Lin C.-C.
        • et al.
        Normal saline instillation before suctioning: a meta-analysis of randomized controlled trials.
        Aust Crit Care. 2017; 30: 260-265
        • Van de Leur J.P.
        • Zwaveling J.H.
        • Loef B.G.
        • Van der Schans C.P.
        Patient recollection of airway suctioning in the ICU: routine versus a minimally invasive procedure.
        Intensive Care Med. 2003; 29: 433-436
        • Pedersen C.M.
        • Rosendahl-Nielsen M.
        • Hjermind J.
        • Egerod I.
        Endotracheal suctioning of the adult intubated patient—what is the evidence?.
        Intensive Crit Care Nurs. 2009; 25: 21-30
        • Favretto D.O.
        • Silveira R.C.
        • Canini S.R.
        • Garbin L.M.
        • Martins F.T.M.
        • Dalri M.C.B.
        Endotracheal suction in intubated critically ill adult patients undergoing mechanical ventilation: a systematic review.
        Rev Lat Am Enfermagem. 2012; 20: 997-1007
        • Couchman B.A.
        • Wetzig S.M.
        • Coyer F.M.
        • Wheeler M.K.
        Nursing care of the mechanically ventilated patient: what does the evidence say?: part one.
        Intensive Crit Care Nurs. 2007; 23: 4-14
        • Bourgault A.M.
        • Brown C.A.
        • Hains S.M.
        • Parlow J.L.
        Effects of endotracheal tube suctioning on arterial oxygen tension and heart rate variability.
        Biol Res Nurs. 2006; 7: 268-278
        • Irajpour A.
        • Abbasinia M.
        • Hoseini A.
        • Kashefi P.
        Effects of shallow and deep endotracheal tube suctioning on cardiovascular indices in patients in intensive care units.
        Iran J Nurs Midwifery Res. 2014; 19: 366-370
        • Jongerden I.P.
        • Kesecioglu J.
        • Speelberg B.
        • Buiting A.G.
        • Leverstein-van Hall M.A.
        • Bonten M.J.
        Changes in heart rate, mean arterial pressure, and oxygen saturation after open and closed endotracheal suctioning: a prospective observational study.
        J Crit Care. 2012; 27: 647-654
        • Paulus F.
        • Binnekade J.M.
        • Vroom M.B.
        • Schultz M.J.
        Benefits and risks of manual hyperinflation in intubated and mechanically ventilated intensive care unit patients: a systematic review.
        Crit Care. 2012; 16: R145
        • Hadian Z.
        • Sabet R.
        The effect of endotracheal tube suctioning education of nurses on decreasing pain in premature neonates.
        Iran J Pediatr. 2013; 23: 340
        • Abbasinia M.
        • Irajpour A.
        • Babaii A.
        • Shamali M.
        • Vahdatnezhad J.
        Comparison the effects of shallow and deep endotracheal tube suctioning on respiratory rate, arterial blood oxygen saturation and number of suctioning in patients hospitalized in the intensive care unit: a randomized controlled trial.
        J Caring Sci. 2014; 3: 157
        • Rafiee H.
        • Iranmanesh S.
        • Sabzevari S.
        Comparison of the endotracheal tube suctioning with and without normal saline solution on heart rate and oxygen saturation.
        Iran J Crit Care Nurs. 2011; 4: 117-120
        • Day T.
        • Farnell S.
        • Wilson-Barnett J.
        Suctioning: a review of current research recommendations.
        Intensive Crit Care Nurs. 2002; 18: 79-89
        • Zahran E.M.
        • El-Razik A.A.
        Tracheal suctioning with versus without saline instillation.
        J Am Sci. 2011; 7: 23-32
        • Bülbül Maraş G.
        • Kocaçal Güler E.
        • Eşer İ.
        • Köse Ş.
        Knowledge and practice of intensive care nurses for endotracheal suctioning in a teaching hospital in western Turkey.
        Intensive Crit Care Nurs. 2017; 39: 45-54
        • Oh H.
        • Seo W.
        A meta-analysis of the effects of various interventions in preventing endotracheal suction-induced hypoxemia.
        J Clin Nurs. 2003; 12: 912-924
        • Akgül S.
        • Akyolcu N.
        Effects of normal saline on endotracheal suctioning.
        J Clin Nurs. 2002; 11: 826-830
        • Özden D.
        • Görgülü R.S.
        Effects of open and closed suction systems on the haemodynamic parameters in cardiac surgery patients.
        Nurs Crit Care. 2015; 20: 118-125
        • Shamali M.
        • Babaii A.
        • Abbasinia M.
        • Shahriari M.
        • Akbari Kaji M.
        • Oren Gradel K.
        Effect of minimally invasive endotracheal tube suctioning on suction-related pain, airway clearance and airway trauma in intubated patients: a randomized controlled trial.
        Nurs Midwifery Stud. 2017; 6: e35909
        • Faul F.
        • Erdfelder E.
        • Lang A.G.
        • Buchner A.
        G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Ahn Y.
        • Hwang T.
        The effects of shallow versus deep endotracheal suctioning on the cytological components of respiratory aspirates in high-risk infants.
        Respiration. 2003; 70: 172-178
        • Gillies D.
        • Spence K.
        Deep versus shallow suction of endotracheal tubes in ventilated neonates and young infants.
        Cochrane Database Syst Rev. 2011; Cd003309
        • Madan A.
        Correlation between the levels of SpO2 and PaO2.
        Lung India. 2017; 34: 307-308
        • Ackerman M.
        • Gugerty B.
        The effect of normal saline bolus instillation in artificial airways.
        J Soc Otorhinolaryngol Head Neck Nurses. 1990; 8: 14-17
        • Giakoumidakis K.
        • Kostaki Z.
        • Patelarou E.
        • Baltopoulos G.
        • Brokalaki H.
        Oxygen saturation and secretion weight after endotracheal suctioning.
        Br J Nurs. 2011; 20