| Background: Tracheal suction is a main and common treatmenttechnique in clinic, however, this technique has some potential flaws. Forexample, conventional suction always using the single-channel suction tubefor trachea shallow suctioning, this procedure largely depends on operators’subjective feeling and experiences, so it may leads to tracheal mucosaldamage, sputum aspiration is not completely and the suction time isincreased. The shallow suctioning only aspirate the sputum in upper of thetrachea, it can’t suck out sputum which is blocking the airways in thedeep side of the trachea completely and may leads to infection.At present, flexible bronchofiberscope and laryngofiberoscope wereused for visual sputum suction. However, the laryngofiberoscope could onlybe observed part of the airways and helpless to the deep side. Thebronchofiberscope needs to perform local anesthesia and yields to thecomplicated operations, furthermore, contraindications in patients undergothis procedure, such as severe depletion, cardiorespiratory functionincompetence, severe heart diseases, aortic aneurysm limit its furtherapplication. And both of the operators should be physicians with extensive experiences and the procedure is complex, the price is costly, so the can notbe widely used in clinical practice.Therefore, a more convenient and effective suction system is necessaryto develop for clinic practice. Recently, our research group designs a visualsputum suction system which integrates mini-optical imaging fiber to showthe real-time image of the suction process. This study aimed to investigatethe feasibility and efficiency for sputum suction with this new systemthrough the experiment in vitro and the animal experiments.Part I The development on visual sputum suction system——thedevelopment on visual sputum suction instrumentObjective: to develop a visual sputum suction system which was usedfor aspiration of sputum in clinic.System design: This ultramicroscopic visual sputum suction systemhas three parts: monitor, endoscope light source system and tracheal suctiontri-catheter. The endoscope light source system (FVS-001MI) has four parts:cold-light camera system, ultramicroscopic-optical fiber, monitor and thecomputer acquisition system. An ultramicroscopic-optical fiber wasdesigned which outer diameter was0.90mm and maximum exploratorylength was2200cm and working portion was50cm, the pixel value wouldbe6000. The diameter of the image bundle was0.45mm and these was a optical lens in the front end. The visual suction catheters used were50cm inlength and had an end hole with a diameter of5mm. The catheters weredivided into three channels: the optical fiber channel (internal diameter=1.50mm), the suction channel (internal diameter=2.50mm), and theoxygen supply channel (internal diameter=1mm).Results: Ultramicroscopic-optical fiber was used for imagingdetection on books and tubes (internal diameter=1.50mm), the pixel valueof the imaging was480,000, it could meet the requirement of suction inclinic. Debugging the white balance button on the light source brightness,the value is selected as the12~15, the imaging effect is best and can clearlyshow the tracheal ring cartilage, simulated sputum and the trachealbifurcation. We suctioned1.5%and3.0%simulant directly into a containerfor15seconds at a pressure of200mm Hg (n=20). The suction amount ofthe conventional TSCs were46.33±9.56g,53.09±8.09g and the amount ofthe tri-cavity TSCs were35.22±1.47g,42.67±3.41g.Conclusions: The miniature fiber imaging technology was using toclinic in the visual suction system. It could implement the visualizationsucking sputum and also could provided the real-time image when suckingsputum, it could meet the requirement of design, and provided completeprototype instrument for bedside sucking operation in clinic. Theconventional TSCs were more efficient than the tri-cavity TSCs (p <0.05,n=20). Thus, our catheter must be improved; it is possible that we could enlarging the diameter of the suction cavity without changing the outsidediameter of the catheter. Part2Experimental studies on visual sputum suction system invitroObjective: to investigate the feasibility and efficiency of a new visualsuction system in vitro, which incorporate ultramicroscopic optical fiber andtracheal suction tri-catheter for providing visible image.Methods: In an in vitro studies, different densities of coagulants wereinjected into the model’s throat and lung pig, we used different suckingphlegm access (mouth cavity, nasal cavity, trachea intubation, tracheaincision) to compare the efficiency of the visual system and conventionalsuctioning.Results: In the simulation dummy suction experiment, when1.5%coagulants were used, by mouth cavity, nasal cavity, tracheostomy tube, theendotracheal tube, the sputum suction quantities by using visual sputumsuction system were11.53±1.18g,10.73±0.66g,11.50±0.71g,10.97±0.85g; the sputum suction quantities by using the current system were10.05±1.76g,9.55±0.64g,10.25±0.91g,9.35±1.38g; when3.0%coagulants were used, the sputum suction quantities by using visual sputumsuction system were11.74±1.67g,10.25±1.15g,11.05±0.97g,11.23±1.79g; the sputum suction quantities by using the current systemwere8.84±1.11g,8.35±1.29g,10.61±1.05g,8.40±1.25g. When suctionin the lung of pig, when1.5%coagulants were used, by direct insertion, thetrachea intubation, the trachea incision, the sputum suction quantities byusing visual sputum suction system were6.91±0.49g,7.27±0.71g,6.59±0.88g, by conventional suctioning were5.28±0.64g,6.39±0.91g,5.98±1.38g; when3.0%coagulants were used, the sputum suctionquantities by using visual sputum suction system were6.37±1.15g,7.98±0.97g,7.35±1.79g, conventional suctioning were5.64±1.29g,6.19±1.05g,6.90±1.25g.Conclusions: The proposed system is faster, easier to operate, andmore efficient than conventional suctioning, which is valued ofpopularization and provide the basis for animal experiment. Part3the sputum suction experiments on animals by visual suctionsystemObjective: to compare the efficiency and security of the visual suctionsystem and the conventional one on animals.Methods:18healthy dog models, were randomly divided into visiblesucking sputum group (n=9) and traditional sucking group (n=9), all ofthem were built to dog sputum crudum modals through organophosphaticinsecticides poisoning. We used different sucking phlegm access (mouthcavity, tracheostomy tube, The endotracheal tube) to compare the efficiencyand tracheal damage degrees of the visual sucking sputum group andtraditional sucking group.Results:(1) In the animal suction experiment, different suckingphlegm access (by mouth cavity, tracheostomy tube, The endotracheal tube),the sputum suction quantities by using visual sputum suction system were7.07±0.71g,8.75±0.68g,8.42±0.76g; the sputum suction quantities byusing the current system were6.60±0.73g,7.78±0.59g,7.55±0.61g.(2)Through collect the records of the dogs’ oxygen saturation, blood gasanalysis data and heart rates in sucking sputum process, the visual sputumsuction group’s oxygen saturation were higher than traditional group (n=36,p <0.05); the heart rates, blood gas analysis data and blood pressures wereno significantly differences (n=36,p>0.05).(3) In HE dyed visible sucking phlegm process, the damages of the visible sucking phlegm group was lessthan the traditional sucking phlegm group (n=9, p <0.05).Conclusions: The visual sputum suction device could provided thereal-time images when sputum suction operation in dog pneumonia modals,compare to the traditional sputum suction system, it is characterized by highefficiency sputum suction, lower tracheal damage degree, and easier tooperate. |
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