Use of Endotracheal Sodium Bicarbonate for Pulmonary Clearance in
Pediatric Patients
Abstract
Background: Few guidelines exist to guide pulmonary clearance therapies
for children receiving invasive mechanical ventilation. In our
institution, we have used sodium bicarbonate solution instilled via
tracheal tube to assist with secretion clearance and improve
atelectasis. Despite reports of its use, there is very little literature
to characterize sodium bicarbonate via tracheal tube in clinical
practice. Methods: We performed an IRB-approved, retrospective chart
review in a single center of all patients who received sodium
bicarbonate via tracheal tube over a 5-year period. We collected data on
how sodium bicarbonate was used and analyzed for any reported
improvement in respiratory status after its use. Results: Fifteen
patients were reviewed. Most received 2.4% sodium bicarbonate via
tracheal tube for an average of three doses of an average of 3.1 mL
instilled. Most patients had documented improvement in chest radiograph
appearance, and several were able to be significantly weaned from
mechanical ventilator settings immediately following use of sodium
bicarbonate. Most had thinner, smaller, and clearer secretions following
use of sodium bicarbonate. There were no adverse events related to use
of sodium bicarbonate. Conclusions: Sodium bicarbonate given via
tracheal tube was safe in our group of patients. There was improvement
in chest radiograph appearance, secretion tenacity, and ventilatory
needs in most of our patients. This was a small, retrospective study of
pediatric patients with very complex medical conditions, and most were
also receiving other forms of pulmonary clearance concomitant with
sodium bicarbonate. Further study is warranted in the form of
prospective, randomized, blinded trials.