suctioning a patient with smoke inhalation injury

[milenchen]

Has anyone suctioned an intubate patient with smoke inhalation injury? what outcome measure did you use to assess the effectiveness of your intervention? Did you use auscultation or blood gas analysis such as CO-oximetry or standard arterial blood gases?

[MartinM]

I wouldn't have thought it should really differ too much from how you'd evaluate normal suctioning - auscultation, palpation, observed work of breathing, pt's reported dyspnoea (if possible), SpO2, may ABGs, weight of sputum (if facilities exist).

One unique thing though is that what you suction up may be black - you could see when the secretions cleared change colour. Are there differences when the patient is in different positions?

Is there anything else?

[milenchen]

Dear Martin, thanks VERY much for your reply! This is all an hypothetical scenario for a case study. One more thing, if I may: have you ever used a CO-oximetre, it's a blood gas analyser that you attach to a normal ABG machine but nobody seems to know about. It gives you a breakdown of the various haemoglobins. If I use a normal ABG machine, which gives me SaP02, on a patient with CO intoxication, would that still give me an accurate picture of the patient's pulmonary exchange status after suctioning? Could high levels of carboxyhaemoglobin interfere with the SaO2 readings?

[vishwagupta_physiomedico]

yes ofcourse the carboxyhaemoglobin will have the effect on SaO2, and endexpiratory CO2 monitoring with SaO2 monitoring might serve the purpose of monitoring during the endotracheal suction in case of the intubated smoke inhalation injury patients

[fire_ice]

hello dear,
The effectiveness of suctioning is usually measured by ,
1.ABG analysis.
2.Auscultation.
3.Work of breathing changes.
4.Sputum volume.
but since the hypothetical scenario is a smoke inhalation so we r dealing with carbon monoxide thus considering Standard ABG analysis is out of question as it will show high oxygen saturation which is misleading.The remaining criteria still holds good and can be used,and i particularly feel that the auscultation should be the first choice as work of breathing and sputum volume can be influenced by other things.
regards