• Mary Lou Sole, Melody Bennett, and Suzanne Ashworth.
• Mary Lou Sole is Orlando Health Distinguished Professor and Pegasus Professor, University of Central Florida, College of Nursing, Orlando, Florida, and a research scientist at Orlando Health, Orlando, Florida. Melody Bennett is a member of the adjunct faculty at the University of Central Florida and a clinical research coordinator at Orlando Health. Suzanne Ashworth is a clinical nurse specialist in neurological critical care at Orlando Regional Medical Center, Orlando, Florida. mary.sole@ucf.edu.
• Am. J. Crit. Care. 2015 Jul 1;24(4):318-24; quiz 325.

BackgroundCritically ill patients who need mechanical ventilation require endotracheal suctioning. Guidelines recommend coarse crackles over the trachea and/or the presence of a sawtooth pattern on the flow-volume loop of the ventilator waveform as the best indicators.ObjectiveTo determine clinical cues for endotracheal suctioning in patients who require mechanical ventilation.MethodsA descriptive study of 42 adult patients receiving mechanical ventilation. After baseline endotracheal suctioning with a closed-system device, patients were assessed hourly up to 4 hours for guideline-based cues for endotracheal suctioning and lung sounds were auscultated. Endotracheal suctioning was done when cues were detected or 4 hours after baseline suctioning. Secretions were collected, measured, and weighed.ResultsMost patients were male (62%) and white (93%). Mean age was 51 years, and mean duration of mechanical ventilation was 7.5 days. The median time to endotracheal suctioning was 2 hours, and a mean of 4.4 mL of secretions was removed. Three patients had no cues identified but had 1.0 mL or more of secretions. The most frequent cues were crackles over the trachea (88%), sawtooth waveform (33%), coughing (29%), and visible secretions (5%). Cues resolved and physiological parameters improved after suctioning. Coarse lung sounds did not improve.ConclusionsPatients receiving mechanical ventilation should be routinely assessed for coarse crackles over the trachea, the most common indicator for endotracheal suctioning. Despite common practice, assessment of lung sounds to identify the need for suctioning is not supported.©2015 American Association of Critical-Care Nurses.

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