ENDOTRACHEAL SUCTIONING CAUSES RIGHT UPPER LOBE COLLAPSE IN INTUBATEDCHILDREN

Objective. Right upper lobe collapse is a common radiographic finding in intubated children. We hypothesized that deep suctioning and uncont rolled negative pressures during endotracheal tube suctioning were sig nificant contributory factors. Methods. The incidence of right upper l obe (RUL) collapse in intubated, ventilated children on a paediatric c ardiac intensive care unit was determined over a 3-month period (n = 1 02). Graduated suction catheters and suction vacuums of < 165 cm H2O w ere then introduced. Another prospective audit was carried out 3 month s later (n = 60). Results: We found that 24% developed RUL collapse an d 1 developed an apical pneumothorax. Following the introduction of gr aduated catheters and controlled vacuums pressures. a significant redu ction in the incidence of RUL collapse to 7% was observed (p < 0.05). Conclusions. We conclude that high negative pressure and deep-suctioni ng causes RUL collapse in children. Any lobar collapse not only prolon gs the child's stay in intensive care, but can be associated with furt her morbidity which may have a serious implication. By improving sucti oning technique this morbidity can be significantly reduced.