Related Experiment Video
Updated: Oct 8, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
The Paediatric AirWay Suction (PAWS) appropriateness guide for endotracheal suction interventions
Jessica Schults1, Karina Charles2, Debbie Long3
1University of Queensland, School of Nursing, Midwifery and Social Work, Australia; Metro North Hospital and Health Service, Queensland, Australia; Child Health Research Centre, The University of Queensland, Queensland, Australia; Paediatric Intensive Care, Queensland Children's Hospital, Queensland, Australia.
Insights
Developing appropriate use criteria for endotracheal suction in children is crucial. This study established guidelines to reduce practice variability and improve outcomes in pediatric intensive care, emphasizing clinically indicated suction.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Evidence-Based Practice
Background:
- Endotracheal suction is a necessary but potentially harmful airway clearance technique for mechanically ventilated children.
- Current practices for endotracheal suction interventions in pediatric populations are variable and complex.
- There is a need for standardized guidelines to optimize patient care.
Purpose of the Study:
- To develop appropriate use criteria for endotracheal suction interventions in pediatric populations.
- To provide a framework for decision-making in airway clearance for critically ill children.
- To reduce practice variability and improve patient outcomes.
Main Methods:
- Utilized the RAND/UCLA Appropriateness Method.
- Engaged a multidisciplinary expert panel.
- Synthesized evidence, developed case scenarios, and conducted two rounds of appropriateness ratings (benefit vs. harm).
Main Results:
- 19% of scenarios were rated appropriate (benefit outweighs harm), 67% uncertain, and 11% inappropriate (harm outweighs benefit).
- Closed suction was generally rated appropriate, especially for infectious respiratory diseases.
- Clinically indicated suction was preferred over routine suction; routine saline use for non-respiratory indications was often inappropriate/uncertain.
Conclusions:
- Appropriate use criteria can guide clinical decision-making and reduce practice variability in pediatric intensive care.
- These criteria have the potential to improve patient outcomes.
- Identifying uncertain scenarios highlights areas for future research in pediatric airway management.
Background/Objective:
Endotracheal suction is an invasive and potentially harmful technique used for airway clearance in mechanically ventilated children. Choice of suction intervention remains a complex and variable process. We sought to develop appropriate use criteria for endotracheal suction interventions used in paediatric populations.
Methods:
The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop the Paediatric AirWay Suction appropriateness guide. This included defining key terms, synthesising current evidence, engaging an expert multidisciplinary panel, case scenario development, and two rounds of appropriateness ratings (weighing harm with benefit). Indications (clinical scenarios) were developed from common applications or anticipated use, current practice guidelines, clinical trial results, and expert consultation.
Results:
Overall, 148 (19%) scenarios were rated as appropriate (benefit outweighs harm), 542 (67%) as uncertain, and 94 (11%) as inappropriate (harm outweighs benefit). Disagreement occurred in 24 (3%) clinical scenarios, namely presuction and postsuction bagging across populations and age groups. In general, the use of closed suction was rated as appropriate, particularly in the subspecialty population 'patients with highly infectious respiratory disease'. Routine application of 0.9% saline for nonrespiratory indications was more likely to be inappropriate/uncertain than appropriate. Panellists preferred clinically indicated suction versus routine suction in most circumstances.
Conclusion:
Appropriate use criteria for endotracheal suction in the paediatric intensive care have the potential to impact clinical decision-making, reduce practice variability, and improve patient outcomes. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research.
Related Concept Videos
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...
01:26Tracheostomy 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...
01:23Tracheostomy Suctioning II: Procedure
01:29Suctioning the Nasopharyngeal Airway
Equipment Required
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
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...