Jessica A Schults1, Marie Cooke, Debbie A Long, Marion L Mitchell. 1. Jessica A. Schults, PhD, RN, is research fellow, Department of Anaesthesia and Pain Management, Queensland Children's Hospital; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University; and Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia. Marie Cooke, PhD, RN, is professor of nursing, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia. Debbie A. Long, PhD, RN, is associate professor and paediatric intensive care nurse researcher, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University; Paediatric Intensive Care Unit, Queensland Children's Hospital; and Paediatric Critical Care Research Group, The University of Queensland, Australia. Marion L. Mitchell, PhD, RN, is professor of critical care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University; and Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia.
Abstract
BACKGROUND: Normal saline instillation (NSI) and lung recruitment manoeuvres (RMs) are used in conjunction with endotracheal suction (ETS) in mechanically ventilated children. Practice is varied, and it is not currently understood what clinical practice guidelines (CPGs) are available to inform practice decisions. OBJECTIVE: The aim of this study was to identify and systematically review the quality of existing ETS CPGs, specifically in the context of NSI and RM use. METHODS: A systematic search for ETS CPGs in children (<18 years old) was conducted in Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, EMBASE, and Google Scholar. Two independent assessors evaluated CPGs using the Appraisal of Guidelines for Research and Evaluation II instrument. Standardised scores were calculated for individual CPGs, and scale domain scores were calculated. RESULTS: Four CPGs and practice recommendations from 2 literature reviews were identified and evaluated. The routine use of NSI and RMs with paediatric ETS was not recommended. Recommendations reflected the low quality and limited availability of evidence to inform NSI and RM application. Collectively, the highest scoring domain was clarity of presentation, followed by scope and purpose (78). Overall assessments ranged from 8 to 100 from a possible 100 points. Four ETS CPGs (100%) were recommended for use with modification. CONCLUSIONS: Clinical practice guidelines and practice recommendations pertaining to NSI and RM were consistent but, however, limited by the quality and volume of available evidence. Clinical practice guideline developers should focus on improving the applicability and rigour in development processes. Further consensus work and rigorous trials are needed to inform future CPGs.
BACKGROUND: Normal saline instillation (NSI) and lung recruitment manoeuvres (RMs) are used in conjunction with endotracheal suction (ETS) in mechanically ventilated children. Practice is varied, and it is not currently understood what clinical practice guidelines (CPGs) are available to inform practice decisions. OBJECTIVE: The aim of this study was to identify and systematically review the quality of existing ETS CPGs, specifically in the context of NSI and RM use. METHODS: A systematic search for ETS CPGs in children (<18 years old) was conducted in Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, EMBASE, and Google Scholar. Two independent assessors evaluated CPGs using the Appraisal of Guidelines for Research and Evaluation II instrument. Standardised scores were calculated for individual CPGs, and scale domain scores were calculated. RESULTS: Four CPGs and practice recommendations from 2 literature reviews were identified and evaluated. The routine use of NSI and RMs with paediatric ETS was not recommended. Recommendations reflected the low quality and limited availability of evidence to inform NSI and RM application. Collectively, the highest scoring domain was clarity of presentation, followed by scope and purpose (78). Overall assessments ranged from 8 to 100 from a possible 100 points. Four ETS CPGs (100%) were recommended for use with modification. CONCLUSIONS: Clinical practice guidelines and practice recommendations pertaining to NSI and RM were consistent but, however, limited by the quality and volume of available evidence. Clinical practice guideline developers should focus on improving the applicability and rigour in development processes. Further consensus work and rigorous trials are needed to inform future CPGs.