• A E Boothroyd, B V Murthy, A Darbyshire, and A J Petros.
• Department of Radiology, Royal Liverpool Children's NHS Trust, UK.
• Acta Paediatr. 1996 Dec 1;85(12):1422-5.

ObjectiveRight upper lobe collapse is a common radiographic finding in intubated children. We hypothesized that deep suctioning and uncontrolled negative pressures during endotracheal tube suctioning were significant contributory factors.MethodsThe incidence of right upper lobe (RUL) collapse in intubated, ventilated children on a paediatric cardiac intensive care unit was determined over a 3-month period (n = 102). Graduated suction catheters and suction vacuums of < 165 cm H2O were then introduced. Another prospective audit was carried out 3 months later (n = 60).ResultsWe found that 24% developed RUL collapse and 4 developed an apical pneumothorax. Following the introduction of graduated catheters and controlled vacuums pressures; a significant reduction in the incidence of RUL collapse, to 7%, was observed (p < 0.05).ConclusionsWe conclude that high negative pressure and deep-suctioning causes RUL collapse in children. Any lobar collapse not only prolongs the child's stay in intensive care, but can be associated with further morbidity which may have a serious implication. By improving suctioning technique this morbidity can be significantly reduced.

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