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A7224 - Airway Mucosal Injury Due to Trauma from Closed Suction Catheter System in Mechanically Ventilated Patients: Findings on Autopsy
Author Block: S. Durrett1, K. Kelly2, V. Maddipati3; 1Pulmonary and Critical Care, Vidant Medical Center/East Carolina University, Greenville, NC, United States, 2Department of Pathology and Labratory Medicine, Vidant Medical Center/ East Carolina University, Greenville, NC, United States, 3Dept. Pulmonary and Critical Care, East Carolina University, Greenville, NC, United States.
Rationale: Endotracheal suctioning is a necessary task in the ICU, performed usually by the nursing staff and respiratory therapist, but little has been done to look into severity, staging, and clinical implication of airway mucosal injury due to closed-suction catheters in mechanically ventilated patients. Existing literature regarding suction catheter injury was done in small sample sizes (Link 1976), often done on animals (Kuzenski 1978), or focused on parameters such as patient discomfort or dysoxia (Day 2002). If these studies did mention mucosal injury they were not able to quantify or grade the severity, but only mentioned “hemorrhagic secretions” after frequent or vigorous suctioning (Maggiore 2013). Methods: Tracheal specimens were collected from recently-intubated, hospitalized patients whose families requested an autopsy. Authorization was provided by the legal next-of-kin with unrestricted permission for a complete autopsy. Autopsy permits were witnessed by nursing staff in person or medical examiner staff by telephone. Tracheas were removed and grossly examined at autopsy. They were then fixed in formalin for approximately 2 weeks. The specimens were then sectioned. Sections were obtained from the proximal trachea (in the area of intubation), the trachea distal to the endotracheal tube, the trachea above the carina and both bronchial branches. Sections were also obtained from areas with gross abnormalities. Tissues were processed and stained routinely. The mucosa was examined to determine the extent of any injury sustained from inline suctioning. Chart review was performed to collect data to determine their duration of intubation, the amount and nature of secretions, and the frequency of suctioning. This damage was compared to the frequency of their suctioning and duration of their intubation. Results: The tracheal tissues of four patients were examined microscopically. The histologic changes were graded from 0 to 4 according to severity. All cases examined showed loss of the respiratory epithelium with variable amounts of inflammation, edema, and involvement of submucosal glands. One patient showed diffuse tracheal necrosis with bacterial collections. Conclusions: Mucosal injury is prevalent in the airways of individuals who undergo suction with closed-suction catheter port during mechanical ventilation. The relative ease of suctioning, lack of standardization in frequency and intensity could worsen injury. The present study, first of its kind in the field in humans in recent decades, demonstrates the findings on autopsy and intends to develop a scoring or staging system. Whether these findings correlate with fevers or other ventilator associated events needs to be further studied.