Instilling small and diluted sodium bicarbonate into artificial airways (ETT or tracheotomy) has been said to be an outdated practice. Some research findings revealed that it predisposes patients to ventilator acquired pneumonia (VAP). Therefore, some settings no longer use it while some others find it useful, as it helps to loosen thick and stubborn secretions in the artificial airway, with good patient outcome.
However, let’s look into the scientific rationale behind the use and effectiveness of sodium bicarbonate in decreasing the viscosity of mucus.
One of the causes of thick secretions is dehydration. It can also be as a result of increased ionic calcium in the mucus. Calcium ions help to condense, package and cross-link mucus granules into goblet cells.
Bicarbonate is a chelating agent that helps to chelate calcium thus reducing the calcium in the secretion. This causes the thick secretions to become loosened, uncondensed and less viscous. Also, the chelated calcium is replaced by extracellular sodium ions which further loosens the secretion and makes it swell and watery (due to its affinity for water).
The above mechanism is such an interesting one to know. Isn’t it?
I am not making any attempt to answer the question that was raised in the beginning of this write up. I just want to ignite some passion for further study in you. Come up with your own conclusion through diligent research on this subject matter. Be scientific. Be knowledgeable. Be a good and effective nurse.
Feel free to share your view on this matter.