Emergency Bear Treats: Weekly Article: Deep Suction Prolongs Bronchiolitis Hospital Stays

by Sonny Tat

This week's article comes on the back end of bronchiolitis season--although the cold of the Snowquester storm might extend RSV just a little longer. It is a study out of Cincinnati published this month in JAMA Pediatrics (which is the Journal Formerly Known as As Archives of Pediatric and Adolescent Medicine) called "Suctioning and Length of Stay in Infants Hospitalized with Bronchiolitis." (Mussman G et al. JAMA Pediatr.2013;():1-8.)

It is a retrospective chart review that examined how different types of mechanical suction might be associated with length of stay in patients from 2-12 months old with bronchiolitis. The study defined deep suctioning as passing the nasopharyngeal catheter and non-invasive suctioning as using just the nasal aspirator. They did not count bulb suctioning.

I thought the interesting thing they did was pro-rate the exposure to different types of suctioning to account for the fact that many patients had both types of suctioning during their stay. For example, if a patient was deep suctioned 5 times and non-invasively suctioned 3 times, the patient would have a 62.5% deep suctioning exposure. In linear regression analysis, they found that there was a 0.6 day increase in hospital LOS in patients who were in the lots of deep suctioning group compared to the little deep suctioning group.

Their proposed mechanism is that deep suctioning causes edema and irritation of the airway. Here's a link to a more comprehensive summary in Family Practice News.

Among other limitations, this study was done on inpatients so we have to question its applicability to our emergency room setting. But perhaps this study suggests that the deep suctioning that parents sometimes clamor for (and UMC rightfully takes pride in) may do more harm than good. Or at least we should remember that few interventions--no matter how utterly satisfying--are completely benign. So next time you decide to drop a nostril-diameter tube through a nare into the distal esophagus, think that there is a chance you are causing "edema and irritation."