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Published on: January 17, 2011
Endotracheal suction interventions in mechanically ventilated children: An integrative review to inform
Jessica A Schults1, Marion L Mitchell2, Marie Cooke3
1Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Queensland, Australia; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia.
Insights
Evidence on pediatric endotracheal suction interventions is limited. Current data suggests closed suction may preserve oxygen levels, but high-quality research is needed to guide practice for mechanically ventilated children.
Area of Science:
- Pediatric critical care medicine
- Respiratory therapy
- Evidence-based practice
Background:
- Endotracheal suctioning is a common procedure for mechanically ventilated children.
- Optimal suctioning techniques and interventions remain debated.
- A critical appraisal of existing evidence is necessary to inform clinical practice.
Purpose of the Study:
- To systematically review and critically appraise the evidence for pediatric endotracheal suction interventions.
- To identify the effects of different suction interventions on outcomes in mechanically ventilated children.
Main Methods:
- Systematic search of CENTRAL, Medline, EMBASE, and EBSCO CINAHL databases from 2003.
- Inclusion of studies on suction interventions in children (≤18 years) on mechanical ventilation.
- Assessment of methodological quality using Cochrane's risk of bias tool or Newcastle-Ottawa Scale and certainty of evidence using GRADE criteria.
Main Results:
- 17 studies involving 1618 children were included.
- Closed suction systems may help maintain arterial oxygen saturation.
- Normal saline instillation before suctioning can cause transient desaturation.
- Lung recruitment post-suctioning offers short-term oxygenation benefits.
Conclusions:
- The current evidence base for pediatric endotracheal suction interventions is limited by a lack of high-quality randomized controlled trials.
- Inconsistencies in study populations, interventions, and risk of bias preclude definitive conclusions.
- Insufficient high-quality evidence exists to guide clinical practice for suctioning in mechanically ventilated children.
Objective:
The objective of this study was to review and critically appraise the evidence for paediatric endotracheal suction interventions.
Data Sources:
A systematic search for studies was undertaken in the electronic databases CENTRAL, Medline, EMBASE, and EBSCO CINAHL from 2003.
Study Selection:
Included studies assessed suction interventions in children (≤18 ys old) receiving mechanical ventilation. The primary outcome was defined a priori as duration of mechanical ventilation. Secondary outcomes included adverse events and measures of gas exchange and lung mechanics.
Data Extraction:
Data extraction were performed independently by two reviewers. Study methodological quality was assessed using Cochrane's risk of bias tool for randomised trials or the Newcastle-Ottawa Scale for observational studies. Overall assessment of the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations criteria.
Results:
Overall 17 studies involving 1618 children and more than 21,834 suction episodes were included in the review. The most common intervention theme was suction system (five studies; 29%). All included trials were at unclear or high risk of performance bias due to the inability to blind interventionists. Current evidence suggests that closed suction may maintain arterial saturations, normal saline leads to significant transient desaturation, and lung recruitment applied after suction offers short-term oxygenation benefit.
Limitations:
Lack of randomised controlled trials, inconsistencies in populations and interventions across studies, and imprecision and risk of bias in included studies precluded data pooling to provide an estimate of interventions effect.
Conclusions:
Based on the results of this integrative review, there is insufficient high-quality evidence to guide practice around suction interventions in mechanically ventilated children.
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