Clearance of bronchial secretions after major surgery

Minimally invasive airway suctioning is equally effective as routine endotracheal suctioning but results in less suction related adverse events, less recollection of suctioning and less stress. Thus, although it cannot be employed in all situations, minimally invasive airway suctioning should be the “default setting” for mucus clearance in ICU-patients. Special suction catheters should be marketed that do not pass the distal tip of the endotracheal tube. Alternatively, standard catheters can be marked to avoid too distal routine suctioning. An ICU can be considered a stressful environment, which may lead to unpleasant memories. It is as yet unclear how these can be avoided. Deeper sedation with standard drugs is not the answer as it increases the incidence of post-traumatic stress syndrome in the aftermath of a period on the ICU. A multidisciplinary team approach for patients discharged after a prolonged stay on the ICU may be appropriate. After discharge of patients from the ICU to the ward current assessment of pulmonary function seems to be inadequate. Actual measurement of pulmonary function with a handheld spirometer should be implemented on the third day post surgery to evaluate possible pulmonary complications.