Mechanically Ventilated ED Patients and Secretion Mobilization
As more of our intubated ED patients remain in the ED for longer periods of time, some may develop problems with secretion management (thick/copious amounts of sputum).
The preferred method of secretion mobilization is heated humidification.
If you anticipate the duration of intubation to be at least 96 hours, have your respiratory therapist set up a heated humidifier.
Commonly, clinicians and nurses will instill 5-10 ml of isotonic saline to thin secretions.
The use of saline to thin secretions is unsupported by the literature and carries a small risk of dislodging the bacterial laden biofilm that covers the endotracheal tube.
References
Robinson BRH, Athota KP, Branson RD. Inhalational therapies in the ICU. Curr Opin Crit Care 2009;15:1-9.
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