Literature DB >> 26830187

A Bedside Decision Tree for Use of Saline With Endotracheal Tube Suctioning in Children.

Erin B Owen1, Charles R Woods2, Justine A O'Flynn2, Megan C Boone2, Aaron W Calhoun2, Vicki L Montgomery2.   

Abstract

BACKGROUND: Endotracheal tube suctioning is necessary for patients receiving mechanical ventilation. Studies examining saline instillation before suctioning have demonstrated mixed results.
METHODS: A prospective study to evaluate whether saline instillation is associated with an increased risk of suctioning-related adverse events in patients 18 years old or younger requiring mechanical ventilation through an endotracheal tube for at least 48 hours when suctioned per protocol using a bedside decision tree.
RESULTS: A total of 1986 suctioning episodes (1003 with saline) were recorded in 69 patients. The most common indication for use of saline was thick secretions (87% of episodes). In 586 suctioning episodes, at least 1 adverse event occurred with increased frequency in the saline group (P < .001). Normal saline was more likely to be associated with hemodynamic instability (P = .04), bronchospasm (P < .001), and oxygen desaturation (P < .001). Patient factors associated with adverse events include younger age (P < .001), a cuffed endotracheal tube (P = .001), endotracheal tube diameter of 4.0 mm or less (P < .001), respiratory or hemodynamic indication for intubation (P < .001), underlying respiratory disease (P < .001), and longer duration of mechanical ventilation (P < .001). Saline instillation (P < .001), endotracheal tube size of 4.0 mm or less (P = .03), and comorbid respiratory diseases (P = .03) were associated with an increased risk of adverse events.
CONCLUSIONS: Saline instillation before endotracheal tube suctioning is associated with hemodynamic instability, bronchospasm, and transient hypoxemia. Saline should be used cautiously, especially in children with a small endotracheal tube and comorbid respiratory disease. ©2016 American Association of Critical-Care Nurses.

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Year:  2016        PMID: 26830187     DOI: 10.4037/ccn2016358

Source DB:  PubMed          Journal:  Crit Care Nurse        ISSN: 0279-5442            Impact factor:   1.708


  1 in total

1.  Normal saline instillation versus no normal saline instillation And lung Recruitment versus no lung recruitment with paediatric Endotracheal Suction: the NARES trial. A study protocol for a pilot, factorial randomised controlled trial.

Authors:  Jessica A Schults; Marie Cooke; Debbie A Long; Andreas Schibler; Robert S Ware; Marion L Mitchell
Journal:  BMJ Open       Date:  2018-01-31       Impact factor: 2.692

  1 in total

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