In the intensive care setting, managing airway secretions effectively is crucial for maintaining ventilator efficiency and patient safety. A recent pilot study examined endotracheal suctioning with expiratory pause as a modified technique for infants in the pediatric intensive care unit (PICU). While closed-system suctioning preserves airway pressure and oxygen supply, it often lacks the clearance efficiency of open systems. However, this new study suggests that adding a specific expiratory pause might bridge that clinical gap.

Benefits of Endotracheal Suctioning with Expiratory Pause

The randomized crossover trial followed ten infants receiving invasive mechanical ventilation for over 24 hours. These patients were receiving neuromuscular blockers and lacked a cough reflex. Researchers compared conventional closed suctioning against a technique utilizing an expiratory pause. Consequently, the results showed a significant increase in the volume of suctioned secretions. Specifically, the endotracheal suctioning with expiratory pause method yielded a mean of 1.4g compared to just 1.1g with the conventional approach.

Furthermore, the study evaluated hemodynamic parameters such as heart rate, blood pressure, and oxygen saturation. Respiratory mechanics, including static compliance, resistance, and driving pressure, were also carefully monitored. Importantly, researchers observed no negative impacts on these critical variables. This suggests that the maneuver is both effective and safe for infants who require stable ventilatory support.

Clinical Implementation in PICU

Doctors often prefer closed-system suctioning because it prevents alveolar collapse and limits environmental contamination. However, its reduced effectiveness in clearing thick secretions remains a persistent challenge for nursing staff. By incorporating a brief pause during the expiratory phase on the ventilator, clinicians may enhance the flow of secretions toward the artificial airway. This adjustment can potentially improve airway patency and reduce the frequency of suction-related interventions without compromising patient stability.

Frequently Asked Questions

Is the expiratory pause technique safe for neonates and infants?

The study indicates that the technique does not cause significant changes in hemodynamic or respiratory mechanics, making it a safe alternative for infants on mechanical ventilation.

Does this technique require disconnecting the ventilator?

No, this maneuver is performed within a closed-system suctioning setup, which allows for the maintenance of positive airway pressure while the expiratory pause is applied through the ventilator settings.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Refer to the latest local and national guidelines for clinical practice.

References

Dattein Peiter AP et al. Effects of Endotracheal Suctioning With Expiratory Pause in Infants. Respir Care. 2026 May 02. doi: 10.1177/19433654261427697. PMID: 42068210.

Schults JA, et al. Endotracheal suctioning of the critically ill child. Intensive Crit Care Nurs. 2020;57:102787. doi:10.1016/j.iccn.2019.102787.

Peiter ADP, et al. Effects of Combined Tracheal Suctioning and Expiratory Pause: A Crossover Randomized Clinical Trial. Respir Care. 2023;68(9):1201-1209.