Detection of Secretion Retention in the Ventilated Patient

Intubation, mechanical ventilation and subsequent immobilization, sedation and drying of airways predisposes to retained secretions. This can lead to a number of complications including endotracheal tube occlusion, ventilator associated infection, hemodynamic compromise and life threatening hypoxemia. Identification of retained secretions can be difficult with a poor specificity for many components of the examination. Ideally, it is important to have a high confidence in the methods of detecting airways secretions in order to be able to effectively manage them in order to prevent an emergent situation developing. The various components of examination including auscultation, oxygenation status, radiology, pulmonary mechanics and waveform analysis are discussed together with validity and repeatability information. Two of the most promising areas for accurate bedside localization of secretions are auscultation and waveform analysis.