Endotracheal Suctioning for Procedural Pain

Overseen By Briana Carr, PhD(c), BSN, RN

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Loma Linda University

Must not be taking: Neuromuscular blockers

Disqualifiers: Low hemoglobin, Jehovah's Witness, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

The goal of this experimental study is to understand if endotracheal tube (ETT) suctioning increases pain and causes stress on the body in intubated adult ICU patients. These patients are already on ventilators, which means they need suctioning to keep their airways clear, but this procedure may be uncomfortable and cause stress. The main questions this study aims to answer are: Does ETT suctioning raise pain levels as measured by the Critical-Care Pain Observation Tool (CPOT)? Does ETT suctioning increase certain chemicals in the blood (hypoxanthine, xanthine, and uric acid) that show stress and lack of oxygen in the body? Researchers will compare patients who have ETT suctioning (intervention group) with those who do not have suctioning during the study period (control group) to see if there are differences in pain and blood markers of stress. Participants will: Have pain measured before and after suctioning using the CPOT. Have blood samples taken from an existing line at three time points: 5 minutes before, 5 minutes after, and 30 minutes after suctioning. Provide demographic information (like age, gender, and diagnosis) from medical records. This research will help improve how pain is managed for ICU patients who cannot speak for themselves, potentially leading to better pain relief methods in the future.

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Endotracheal Tube Suctioning for procedural pain?

Research indicates that endotracheal suctioning is a painful procedure, and studies have explored ways to manage this pain, such as music therapy, which has shown some effectiveness in providing relief during the procedure. ^{1 2 3 4 5}

Is endotracheal suctioning safe for humans?

Endotracheal suctioning is generally considered safe, but it is known to be a painful procedure for patients, especially those who are critically ill or undergoing mechanical ventilation. ^{1 2 3 4 5}

How is endotracheal tube suctioning different from other treatments for procedural pain?

Endotracheal tube suctioning is unique because it is a necessary procedure for patients on mechanical ventilation, but it is known to be painful and distressing. Unlike other treatments that might involve medication, this procedure is physical and involves removing secretions from the airway, which can cause discomfort. ^{1 2 3 4 5}

Research Team

Elizabeth Johnston Taylor, PhD, FAAN

Principal Investigator

Loma Linda University School of Nursing

Eligibility Criteria

This trial is for adult ICU patients who are critically ill and intubated, meaning they have a tube inserted to help them breathe. It's suitable for those with conditions like influenza, pneumonia, sepsis or COVID-19. Patients must be able to provide blood samples and have their pain assessed using the CPOT.

Inclusion Criteria

I am 18 years old or older.

I am currently diagnosed with flu, pneumonia, COVID, or sepsis.

I am on a breathing machine.

Exclusion Criteria

I am currently taking medication for muscle control.

Contraindications for blood draws (hemoglobin levels below 8.0 g/dL; Jehovah's Witness)

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Observation

Participants undergo observation with or without endotracheal tube (ETT) suctioning to assess pain and serum markers

1 day

1 visit (in-person)

Follow-up

Participants are monitored for changes in pain levels and serum markers post-suctioning

30 minutes

Treatment Details

Interventions

• Endotracheal Tube Suctioning (Procedure)

Trial Overview The study tests whether endotracheal tube suctioning increases pain or stress in the body by measuring changes in pain levels with the CPOT and checking blood markers before and after suctioning. Some patients will receive regular suctioning while others won't, to compare outcomes.

Participant Groups

Group I: Participants who undergo endotracheal tube (ETT) suctioning. Experimental Treatment 1 Intervention

Participants will receive ETT suctioning as part of routine care.

Group II: Participants who do not undergo ETT suctioning during the observation period. Active Control 1 Intervention

Participants will not receive ETT suctioning during the observation periood.

Who Is Running the Clinical Trial?

Loma Linda University

Lead Sponsor

Trials

322

Recruited

267,000+

Findings from Research

In a randomized controlled trial involving 98 patients on mechanical ventilation, music therapy significantly reduced pain scores during endotracheal suctioning compared to standard care, indicating its effectiveness as a pain relief method.

The study utilized two observational pain tools, showing consistent results that support music therapy as a beneficial nonpharmacological intervention for managing procedural pain in critically ill patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Relief of Procedural Pain in Critically Ill Patients by Music Therapy: A Randomized Controlled Trial. Yaman Aktaş, Y., Karabulut, N.[2019]

In a qualitative study involving 10 post-operative cardiac surgical patients, many participants did not recall their experience with endotracheal suction, and half had no memory of the endotracheal tube itself, suggesting a potential lack of awareness or distress related to these interventions during short-term mechanical ventilation.

Participants described the endotracheal tube as bothersome but not painful, indicating that while it may be uncomfortable, it does not significantly detract from their overall experience, which can inform better pre- and post-operative care planning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient's experiences of endotracheal tubes and suction following cardiac surgery. Gilder, E., Jull, A., Slark, J., et al.[2022]

Music therapy significantly reduced pain intensity and improved sedation levels during endotracheal suctioning in mechanically ventilated patients, as shown by lower scores on the Critical-Care Pain Observation Tool and higher scores on the Ramsay Sedation Scale in the experimental group compared to the control group.

The study involved 66 patients over a period from May 2010 to June 2013, and while music therapy improved pain and sedation, it did not significantly affect physiological parameters like blood pressure, heart rate, or oxygen saturation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of music therapy in endotracheal suctioning of mechanically ventilated patients. Yaman Aktaş, Y., Karabulut, N.[2018]

Education for nurses on endotracheal tube suctioning (ETS) significantly improved their performance, leading to a reduction in pain experienced by neonates during and after the procedure, as shown by a significant difference in pain scores (P≤0.01).

Despite the improvements from education, neonates still experienced mild pain during ETS, indicating that additional pain management strategies should be considered to further alleviate discomfort.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of endotracheal tube suctioning education of nurses on decreasing pain in premature neonates. Hadian, ZS., Sabet, RS.[2021]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

Relief of Procedural Pain in Critically Ill Patients by Music Therapy: A Randomized Controlled Trial. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Dimensions of procedural pain and its analgesic management in critically ill surgical patients. [2022]

3. England pubmed.ncbi.nlm.nih.gov

Patient's experiences of endotracheal tubes and suction following cardiac surgery. [2022]

4. England pubmed.ncbi.nlm.nih.gov

The effects of music therapy in endotracheal suctioning of mechanically ventilated patients. [2018]

5. Netherlands pubmed.ncbi.nlm.nih.gov

The effect of endotracheal tube suctioning education of nurses on decreasing pain in premature neonates. [2021]