P G Woodgate1, V Flenady. 1. Department of Neonatology, Mater Mother's Hospital, Raymond Terrace, South Brisbane, Brisbane, Queensland, Australia, 4101. PWOODGAT@mater.org.au
Abstract
BACKGROUND: Assisted mechanical ventilation is the mainstay of management of a variety of conditions affecting the neonate. However there are a number of potential hazards associated with this life saving intervention. New suctioning techniques have been introduced into clinical practice which aim to prevent or reduce these untoward effects. OBJECTIVES: To assess the effects of endotracheal suctioning without disconnection in intubated ventilated neonates. SEARCH STRATEGY: The review has drawn on the search strategy for the Cochrane Neonatal Review Group. A comprehensive search of MEDLINE, Cochrane Library, MEDLINE and CINAHL databases was undertaken by the reviewers. SELECTION CRITERIA: All trials utilizing random or quasi-random patient allocation in which suctioning with or without disconnection from the ventilator is compared in the neonatal population. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Neonatal Group were used. Each author reviewed trials for eligibility and quality and extracted data separately, then compared and resolved differences. Analysis was performed using the fixed effects model and outcomes were reported using relative risk for categorical data and weighted mean difference for outcomes measured on a continuous scale. MAIN RESULTS: Two trials (22 infants) were included in this review. The trials employed a cross-over design in which suctioning with or without disconnection was compared. Suctioning without disconnection resulted in a reduction in episodes of hypoxia (RR 0.30, 95% CI 0.11, 0.80) and a smaller percentage decrease in the TcPO2 (WMD 18.5%, 95% CI 8.11, 28.89). There were also fewer infants who experienced episodes where TcPO2 decreased by > 10% (RR 0.36, 95% CI 0.17, 0.79). Suctioning without disconnection resulted in a smaller percentage decrease in heart rate (WMD 11.53%, 95% CI 3.64, 19.43) and a reduction in the number of infants experiencing a decrease in heart rate by > 10% (RR 0.56, 95% CI 0.32, 0.99). REVIEWER'S CONCLUSIONS: Based upon the results of this review, there is insufficient evidence to decide between endotracheal suctioning with or without disconnection. There is, however, evidence of some benefit from performing suctioning without disconnection for some specific short-term outcomes. Further research should be undertaken to fully assess this practice with particular focus on extremely low birth weight infants and different modes of mechanical ventilation, and to address clinically important outcomes.
BACKGROUND: Assisted mechanical ventilation is the mainstay of management of a variety of conditions affecting the neonate. However there are a number of potential hazards associated with this life saving intervention. New suctioning techniques have been introduced into clinical practice which aim to prevent or reduce these untoward effects. OBJECTIVES: To assess the effects of endotracheal suctioning without disconnection in intubated ventilated neonates. SEARCH STRATEGY: The review has drawn on the search strategy for the Cochrane Neonatal Review Group. A comprehensive search of MEDLINE, Cochrane Library, MEDLINE and CINAHL databases was undertaken by the reviewers. SELECTION CRITERIA: All trials utilizing random or quasi-random patient allocation in which suctioning with or without disconnection from the ventilator is compared in the neonatal population. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Neonatal Group were used. Each author reviewed trials for eligibility and quality and extracted data separately, then compared and resolved differences. Analysis was performed using the fixed effects model and outcomes were reported using relative risk for categorical data and weighted mean difference for outcomes measured on a continuous scale. MAIN RESULTS: Two trials (22 infants) were included in this review. The trials employed a cross-over design in which suctioning with or without disconnection was compared. Suctioning without disconnection resulted in a reduction in episodes of hypoxia (RR 0.30, 95% CI 0.11, 0.80) and a smaller percentage decrease in the TcPO2 (WMD 18.5%, 95% CI 8.11, 28.89). There were also fewer infants who experienced episodes where TcPO2 decreased by > 10% (RR 0.36, 95% CI 0.17, 0.79). Suctioning without disconnection resulted in a smaller percentage decrease in heart rate (WMD 11.53%, 95% CI 3.64, 19.43) and a reduction in the number of infants experiencing a decrease in heart rate by > 10% (RR 0.56, 95% CI 0.32, 0.99). REVIEWER'S CONCLUSIONS: Based upon the results of this review, there is insufficient evidence to decide between endotracheal suctioning with or without disconnection. There is, however, evidence of some benefit from performing suctioning without disconnection for some specific short-term outcomes. Further research should be undertaken to fully assess this practice with particular focus on extremely low birth weight infants and different modes of mechanical ventilation, and to address clinically important outcomes.