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Endotracheal tube care in ICU

Presence of ETT prevents effective coughing, swallowing, and secretion removal. It promotes development of a viscous biofilm which promotes bacterial growth and adherence.
Suctioning is done to
  1. Remove secretions
  2. Decrease airway resistance
  3. Improve gas exchange
  4. Improves risk of infection
Two method
  1. Open
  2. Closed

Indication of closed system of suctioning

  1. high ventilatory requirement- PEEP > 10, mean airway pressure > 20, inspiratory time > 1.5 secs, Fio2 > 0.6
  2. active infection
    The tracheal tube cuff helps to maintain adequate air seal and decrease risk of aspiration
    The tracheal capillary perfusion pressure is normally 25- 35 mm Hg.
    High risk of aspiration if pressure less than 18 mmHg
    So cuff pressure should be between 18-25 mmHg

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