Endotracheal Suctioning for Procedural Pain

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

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Loma Linda University

Must not be taking: Neuromuscular blockers

Disqualifiers: Low hemoglobin, Jehovah's Witness, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

110 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine whether endotracheal tube (ETT) suctioning causes pain and stress in adult ICU patients on ventilators. Researchers seek to assess if this suctioning raises pain levels and increases stress-related chemicals in the blood. Participants will either undergo ETT suctioning or not, and their pain levels and blood markers will be compared. The study seeks adults who are intubated, on ventilators, and have conditions such as flu, pneumonia, COVID, or sepsis. As an unphased trial, it offers participants the opportunity to contribute to important research that may enhance ICU care practices.

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 prior data suggests that endotracheal tube suctioning is safe for intubated adult ICU patients?

Research shows that suctioning the breathing tube (endotracheal tube or ETT) is generally safe, though it can be painful, especially for very sick patients. Studies have found that this procedure can cause discomfort and stress, making pain management important.

No specific reports have identified serious problems directly caused by ETT suctioning. However, patients often experience pain and stress. To enhance comfort, nurses and doctors sometimes use pain relief methods, including administering medication before the procedure.

In summary, while ETT suctioning is necessary for patients on ventilators, it can be uncomfortable. Efforts are made to minimize pain. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how endotracheal tube (ETT) suctioning might influence procedural pain, an area that hasn't been extensively studied. Unlike traditional pain management methods, which often rely on medications, this trial investigates a simple, non-drug intervention that is part of routine care in many medical settings. By examining the effects of ETT suctioning, researchers hope to better understand its impact on patients' comfort and potentially refine care practices to enhance patient outcomes during procedures.

What evidence suggests that endotracheal tube suctioning affects pain and stress in ICU patients?

Research has shown that suctioning the breathing tube (endotracheal tube or ETT) can cause pain and stress for patients. One study found that half of the patients experienced moderate to severe pain during this procedure. It can also lead to changes in heart rate and blood pressure, indicating stress. Another study found no significant difference in pain or changes in heart rate and oxygen levels between the open and closed suctioning systems. This trial will compare participants who undergo ETT suctioning with those who do not during the observation period. These findings suggest that ETT suctioning might be uncomfortable and stressful, highlighting the need for proper pain management. ^{3 4 6 7 8}

Who Is on the Research Team?

Elizabeth Johnston Taylor, PhD, FAAN

Principal Investigator

Loma Linda University School of Nursing

Are You a Good Fit for This Trial?

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

I am on a breathing machine.

I have an arterial line placed.

Exclusion Criteria

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

I am currently taking medication for muscle control.

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

Interventions

• Endotracheal Tube Suctioning

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

Patients experienced lower pain intensity during endotracheal suctioning (average score of 4.9) compared to chest tube removal (average score of 6.6), indicating that chest tube removal is generally more painful.

Despite the pain reported during these procedures, patients received minimal preprocedural analgesics, and there was a low correlation between the amount of analgesics administered and the pain experienced, suggesting a need for better pain management strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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

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]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4825219/

The Effect of Facilitated Tucking during Endotracheal ... This paper is the report of a study that examined the impact of facilitated tucking position on behavioral pain during suctioning in premature neonates.

2. withpower.com withpower.com/trial/phase-critical-illness-2025-be549

Endotracheal Suctioning for Procedural Pain 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 ...

3. internationaljournalofcaringsciences.org internationaljournalofcaringsciences.org/docs/31.akineroglu.pdf

The Effects of Endotracheal Suctioning and Invasive ... The pain behaviors and hemodynamic parameters were evaluated 4 times in total (before the procedure, during the procedure, 5 minutes, and 15 minutes after the ...

4. scivisionpub.com scivisionpub.com/pdfs/pain-management-during-endotracheal-tube-suctioning-an-evidencebased-approach-for-nurses-168.pdf

Pain Management during Endotracheal Tube Suctioning Fifty percent of the patients undergoing endotracheal tube suctioning experienced moderate to severe pain [5].

5. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0882596324003488

The effects of open and closed suctioning systems on ... The study concludes that there is no significant difference between open and closed suctioning techniques concerning pain, peak heart rate, and oxygen ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT06692400

The Effects of Endotracheal Suctioning on Pain and Serum ... 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 ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7050166/

Knowledge and Practices of Endotracheal Suctioning ... A systematic review was conducted to explore the gaps in the existing practices of nurses and thus proposing comprehensive guidelines for safe practice.

8. researchgate.net researchgate.net/publication/330985782_Pain_Management_during_Endotracheal_Tube_Suctioning_An_EvidenceBased_Approach_for_Nurses

Pain Management during Endotracheal Tube Suctioning Objective: The aim of this comparative and prospective study is to evaluate the results of pain management with the association of a mini- ...