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 ICU patients. These patients are already on ventilators, which means they need suctioning to keep their airways clear, but this procedure may be uncomfortable and cause stress.

The main questions this study aims to answer are:

Does ETT suctioning raise pain levels as measured by the Critical-Care Pain Observation Tool (CPOT)? Does ETT suctioning increase certain chemicals in the blood (hypoxanthine, xanthine, and uric acid) that show stress and lack of oxygen in the body? Researchers will compare patients who have ETT suctioning (intervention group) with those who do not have suctioning during the study period (control group) to see if there are differences in pain and blood markers of stress.

Participants will:

Have pain measured before and after suctioning using the CPOT. Have blood samples taken from an existing line at three time points: 5 minutes before, 5 minutes after, and 30 minutes after suctioning.

Provide demographic information (like age, gender, and diagnosis) from medical records.

This research will help improve how pain is managed for ICU patients who cannot speak for themselves, potentially leading to better pain relief methods in the future.

Inclusion Criteria:

• Adults (aged 18 years and older)
• Current diagnosis of flu, pneumonia, COVID, or sepsis
• Intubated and receiving mechanical ventilation.
• Have arterial lines placed
• Require endotracheal suctioning as part of their care

Exclusion Criteria:

• Patients receiving neuromuscular blocking agents
• Contraindications for blood draws (hemoglobin levels below 8.0 g/dL; Jehovah's Witness)

Following the completion of this experiment, specific IPD will be shared in de-identified form to support transparency, replication, and further research:

Demographic data (age, gender, diagnosis) relevant to understanding participant characteristics.

Pain assessment scores (Critical-Care Pain Observation Tool [CPOT] scores) collected at baseline, 5 minutes, and 30 minutes post-suctioning.

Biochemical marker levels for hypoxanthine, xanthine, and uric acid, measured at the same time points.

The IPD will be accessible to qualified researchers upon reasonable request and after ethical and institutional review, following institutional and regulatory guidelines for data sharing. Data will be shared primarily for the purposes of publication in peer-reviewed journals and to facilitate future studies that may enhance supportive care protocols for ICU patients. The data will be available through an encrypted institutional repository to ensure participant confidentiality and data security.

Beginning 6 months after publication with no end date

Who: Researchers with a verified institutional affiliation and approval from their IRB or ethics committee, as applicable. Requests from researchers affiliated with reputable institutions will be reviewed by the primary investigator and the Loma Linda University Health IRB.

What: De-identified IPD, including Demographic data (age, gender, diagnosis); CPOT pain scores recorded at baseline, 5 minutes, and 30 minutes post-suctioning; Biochemical marker levels (hypoxanthine, xanthine, uric acid) measured at the same time points.

Relevant study protocols and descriptions of data collection and processing procedures.

How: Interested researchers must submit a data access request, including a brief research proposal, institutional affiliation, and IRB or ethics approval. Approved researchers will sign a Data Use Agreement (DUA) outlining the terms of use, data confidentiality requirements, and publication guidelines. Access will be provided through a secure, encrypted institutional repository.

The lab technician who results the labs will be blinded.