Related Experiment Video
Updated: Jul 3, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
A comprehensive review of pediatric endotracheal suctioning: Effects, indications, and clinical practice
Brenda M Morrow1, Andrew C Argent
1Division of Paediatric Critical Care and Children's Heart Disease, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. brenda.morrowuct.ac.za
Insights
Pediatric endotracheal suctioning lacks strong evidence, often causing complications rather than improving lung mechanics. Practice should focus on removing secretions, not routine use, with more research needed.
Area of Science:
- Pediatric critical care medicine
- Respiratory therapy
- Evidence-based practice
Background:
- Endotracheal suctioning is a common procedure in pediatric intensive care units.
- Despite its frequent use, there is a significant lack of high-level evidence supporting its efficacy and safety in children.
Purpose of the Study:
- To conduct a comprehensive review of existing literature on pediatric endotracheal suctioning.
- To evaluate the effects, indications, and current clinical practices related to endotracheal suctioning in pediatric patients.
Main Methods:
- A systematic literature search was performed using PubMed, CINAHL, and PEDro databases.
- Included studies were published in English between 1962 and June 2007, encompassing neonatal, pediatric, and adult data due to limited pediatric-specific research.
Main Results:
- A review of 118 references revealed a paucity of high-quality evidence for pediatric endotracheal suctioning.
- Suctioning can lead to serious complications and may negatively impact lung mechanics; it should be reserved for cases with obstructive secretions.
- Evidence does not support routine saline instillation or specific vacuum pressures/catheter sizes, and sterility may not be essential.
Conclusions:
- Limited evidence supports current pediatric endotracheal suctioning practices.
- Further controlled clinical studies are essential to establish evidence-based protocols for suctioning infants and children.
- Research should investigate the impact of different suctioning techniques on ventilation duration, infection rates, and length of hospital stay.
Objective:
To provide a comprehensive, evidence-based review of pediatric endotracheal suctioning: effects, indications, and clinical practice.
Methods:
PubMed, Cumulative Index of Nursing and Allied Health Literature, and PEDro (Physiotherapy Evidence Database) electronic databases were searched for English language articles, published between 1962 and June 2007. Owing to the paucity of objective pediatric data, all reports dealing with this topic were examined, including adult and neonatal studies.
Results:
One hundred eighteen references were included in the final review. Despite the widespread use of endotracheal suctioning, very little high-level evidence dealing with pediatric endotracheal suctioning exists. Studies of mechanically ventilated neonatal, pediatric, and adult patients have shown that suctioning causes a range of potentially serious complications. Current practice guidelines are not based on evidence from controlled clinical trials. There is no clear evidence that endotracheal suctioning improves respiratory mechanics, with most studies pointing to the detrimental effect it has on lung mechanics. Suctioning should be performed when obstructive secretions are present rather than routinely. There is no clear evidence for the superiority of closed- or open-system suctioning, nor is there clear evidence for appropriate vacuum pressures and suction catheter size. Sterility does not seem to be necessary when suctioning. Preoxygenation has short-term benefits, but the longer-term impact is unknown. Routine saline instillation before suctioning should not be performed. Recruitment maneuvers performed after suctioning have not been shown to be useful as standard practice.
Conclusions:
Endotracheal suctioning is a procedure used regularly in the pediatric intensive care unit. Despite this, good evidence supporting its practice is limited. Further, controlled clinical studies are needed to develop evidence-based protocols for endotracheal suctioning of infants and children, and to examine the impact of different suctioning techniques on the duration of ventilatory support, incidence of nosocomial infection, and length of pediatric intensive care unit and hospital stay.
Related Concept Videos
01:23Tracheostomy Suctioning II: Procedure
01:26Tracheostomy Suctioning I: Pre-Procedural Steps
Equipment Required
First, gather all necessary equipment: a sterile suction catheter, a sterile disposable container, sterile gloves, a towel or...
01:25Suctioning the Oropharyngeal Airway
After assembling the equipment, the nurse should practice hand hygiene and don appropriate PPE according to infection control guidelines to avoid the...
01:29Suctioning the Nasopharyngeal Airway
Equipment Required
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...