2020 clinical practice guidelines of endotracheal suctioning in neonates with mechanical ventilation
Evidence-Based Medicine Group, Neonatologist Society, Chinese Medical Doctor Association, Respiratory Group, Neonatologist Society, Chinese Medical Doctor Association
Abstract：Endotracheal suctioning is a most frequent invasive procedure in neonates undergoing mechanical ventilation. The procedure includes the patient preparation, airway suctioning and follow-up care, which may associated with adverse events. Based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE), as well as the related research both in China and overseas, the clinical practice guidelines of endotracheal suctioning in neonates with mechanical ventilation is developed in order to promote the standard implementation of this operation and ensure patients' safety.
American Association for Respiratory Care. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010[J]. Respir Care, 2010, 55(6):758-764.
[2]
Fisk AC. The effects of endotracheal suctioning in the pediatric population:an integrative review[J]. Dimens Crit Care Nurs, 2018, 37(1):44-56.
[3]
Kiraly NJ, Tingay DG, Mills JF, et al. Negative tracheal pressure during neonatal endotracheal suction[J]. Pediatr Res, 2008, 64(1):29-33.
[4]
Gardner DL, Shirland L. Evidence-based guideline for suctioning the intubated neonate and infant[J]. Neonatal Netw, 2009, 28(5):281-302.
[5]
González-Cabello H, Furuya ME, Vargas MH, et al. Evaluation of antihypoxemic maneuvers before tracheal aspiration in mechanically ventilated newborns[J]. Pediatr Pulmonol, 2005, 39(1):46-50.
[6]
Barker DP, Rutter N. Exposure to invasive procedures in neonatal intensive care unit admissions[J]. Arch Dis Child Fetal Neonatal Ed, 1995, 72(1):F47-F48.
[7]
Carhuapoma JR, Williams MA. Endotracheal suctioning and cerebral ischemia in traumatic brain injury:the "phantom menace?"[J]. Crit Care Med, 1999, 27(12):2843-2844.
[8]
Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations[J]. BMJ, 2004, 328(7454):1490.
[9]
Gonçalves RL, Tsuzuki LM, Carvalho MG. Endotracheal suctioning in intubated newborns:an integrative literature review[J]. Rev Bras Ter Intensiva, 2015, 27(3):284-292.
[10]
Mwakanyanga ET, Masika GM, Tarimo EAM. Intensive care nurses' knowledge and practice on endotracheal suctioning of the intubated patient:a quantitative cross-sectional observational study[J]. PLoS One, 2018, 13(8):e0201743.
[11]
Paula LC, Ceccon ME. Randomized, comparative analysis between two tracheal suction systems in neonates[J]. Rev Assoc Med Bras (1992), 2010, 56(4):434-439.
[12]
Celik SS, Elbas NO. The standard of suction for patients undergoing endotracheal intubation[J]. Intensive Crit Care Nurs, 2000, 16(3):191-198.
[13]
Pedersen CM, Rosendahl-Nielsen M, Hjermind J, et al. Endotracheal suctioning of the adult intubated patient-what is the evidence?[J]. Intensive Crit Care Nurs, 2009, 25(1):21-30.
[14]
Wilson G, Hughes G, Rennie J, et al. Evaluation of two endotracheal suction regimes in babies ventilated for respiratory distress syndrome[J]. Early Hum Dev, 1991, 25(2):87-90.
[15]
Cordero L, Sananes M, Ayers LW. A comparison of two airway suctioning frequencies in mechanically ventilated, very-low-birthweight infants[J]. Respir Care, 2001, 46(8):783-788.
[16]
Bruschettini M, Zappettini S, Moja L, et al. Frequency of endotracheal suctioning for the prevention of respiratory morbidity in ventilated newborns[J]. Cochrane Database Syst Rev, 2016, 3:CD011493.
[17]
Rosa FK, Roese CA, Savi A, et al. Behavior of the lung mechanics after the application of protocol of chest physiotherapy and aspiration tracheal in patients with invasive mechanical ventilation[J]. Rev Bras Ter Intensiva, 2007, 19(2):170-175.
Vanner R, Bick E. Tracheal pressures during open suctioning[J]. Anaesthesia, 2008, 63(3):313-315.
[20]
Boothroyd AE, Murthy BV, Darbyshire A, et al. Endotracheal suctioning causes right upper lobe collapse in intubated children[J]. Acta Paediatr, 1996, 85(12):1422-1425.
[21]
Morrow BM, Futter MJ, Argent AC. Endotracheal suctioning:from principles to practice[J]. Intensive Care Med, 2004, 30(6):1167-1174.
[22]
Copnell B, Dargaville PA, Ryan EM, et al. The effect of suction method, catheter size, and suction pressure on lung volume changes during endotracheal suction in piglets[J]. Pediatr Res, 2009, 66(4):405-410.
[23]
Day T, Farnell S, Wilson-Barnett J. Suctioning:a review of current research recommendations[J]. Intensive Crit Care Nurs, 2002, 18(2):79-89.
[24]
Tu CF, Kao HM, Chang YJ, et al. Development of evidence-based clinical practice guidelines for endotracheal suction in premature infants[J]. Hu Li Za Zhi, 2014, 61(1):42-53.
[25]
Pritchard MA, Flenady V, Woodgate P. Systematic review of the role of pre-oxygenation for tracheal suctioning in ventilated newborn infants[J]. J Paediatr Child Health, 2003, 39(3):163-165.
[26]
Tolles CL, Stone KS. National survey of neonatal endotracheal suctioning practices[J]. Neonatal Netw, 1990, 9(2):7-14.
[27]
Taylor DL, Edwards AD, Mehmet H. Oxidative metabolism, apoptosis and perinatal brain injury[J]. Brain Pathol, 1999, 9(1):93-117.
Pritchard M, Flenady V, Woodgate P. Preoxygenation for tracheal suctioning in intubated, ventilated newborn infants[J]. Cochrane Database Syst Rev, 2001, 2001(3):CD000427.
[30]
Rogge JA, Bunde L, Baun MM. Effectiveness of oxygen concentrations of less than 100% before and after endotracheal suction in patients with chronic obstructive pulmonary disease[J]. Heart Lung, 1989, 18(1):64-71.
[31]
American Academy of Pediatrics, American Heart Association, Weiner GM, et al. Textbook of Neonatal Resuscitation[M]. 7th ed. Illinois:American Academy of Pediatrics, 2016:139-158.
[32]
Clifton-Koeppel R. Endotracheal tube suctioning in the newborn:a review of the literature[J]. Newborn Infant Nurs Rev, 2006, 6(2):94-99.
[33]
Youngmee A, Yonghoon J. The effects of the shallow and the deep endotracheal suctioning on oxygen saturation and heart rate in high-risk infants[J]. Int J Nurs Stud, 2003, 40(2):97-104.
[34]
Brodsky L, Reidy M, Stanievich JF. The effects of suctioning techniques on the distal tracheal mucosa in intubated low birth weight infants[J]. Int J Pediatr Otorhinolaryngol, 1987, 14(1):1-14.
[35]
Bailey C, Kattwinkel J, Teja K, et al. Shallow versus deep endotracheal suctioning in young rabbits:pathologic effects on the tracheobronchial wall[J]. Pediatrics, 1988, 82(5):746-751.
[36]
Gillies D, Spence K. Deep versus shallow suction of endotracheal tubes in ventilated neonates and young infants[J]. Cochrane Database Syst Rev, 2011, (7):CD003309. DOI:10.1002/14651858.CD003309.pub2.
[37]
Smith SJ. Suctioning the airway[J]. Emergency, 1993, 25(3):41-45.
[38]
Glass CA, Grap MJ. Ten tips for safer suctioning[J]. Am J Nurs, 1995, 95(5):51-53.
[39]
Runton N. Suctioning artificial airways in children:appropriate technique[J]. Pediatr Nurs, 1992, 18(2):115-118.
[40]
Evans J, Syddall S, Butt W, et al. Comparison of open and closed suction on safety, efficacy and nursing time in a paediatric intensive care unit[J]. Aust Crit Care, 2014, 27(2):70-76.
[41]
Kalyn A, Blatz S, Sandra Feuerstake, et al. Closed suctioning of intubated neonates maintains better physiologic stability:a randomized trial[J]. J Perinatol, 2003, 23(3):218-222.
[42]
Choong K, Chatrkaw P, Frndova H, et al. Comparison of loss in lung volume with open versus in-line catheter endotracheal suctioning[J]. Pediatr Crit Care Med, 2003, 4(1):69-73.
[43]
Cordero L, Sananes M, Ayers LW. Comparison of a closed (Trach Care Mac) with an open endotracheal suction system in small premature infants[J]. J Perinatol, 2000, 20(3):151-156.
[44]
Taylor JE, Hawley G, Flenady V, et al. Tracheal suctioning without disconnection in intubated ventilated neonates[J]. Cochrane Database Syst Rev, 2011, 12(12):CD003065.
[45]
Al-Khafaji A, Manning HL. Inappropriate ventilator triggering caused by an in-line suction catheter[J]. Intensive Care Med, 2002, 28(4):515-519.
[46]
Cobley M, Atkins M, Jones PL, et al. Environmental contamination during tracheal suction. A comparison of disposable conventional catheters with a multiple-use closed system device[J]. Anaesthesia, 1991, 46(11):957-961.
[47]
Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care[M]. 10th ed. Louis, Missouri:Elsevier, 2013:956-958.
[48]
Morrow BM, Mowzer R, Pitcher R, et al. Investigation into the effect of closed-system suctioning on the frequency of pediatric ventilator-associated pneumonia in a developing country[J]. Pediatr Crit Care Med, 2012, 13(1):e25-e32.
[49]
Darvas JA, Hawkins LG. The closed tracheal suction catheter:24 hour or 48 hour change?[J]. Aust Crit Care, 2003, 16(3):86-92.
[50]
Stoller JK, Orens DK, Fatica C, et al. Weekly versus daily changes of in-line suction catheters:impact on rates of ventilator-associated pneumonia and associated costs[J]. Respir Care, 2003, 48(5):494-499.
[51]
Kollef MH, Prentice D, Shapiro SD, et al. Mechanical ventilation with or without daily changes of in-line suction catheters[J]. Am J Respir Crit Care Med, 1997, 156(2 Pt 1):466-472.
Owen EB, Woods CR, O'Flynn JA, et al. A bedside decision tree for use of saline with endotracheal tube suctioning in children[J]. Crit Care Nurse, 2016, 36(1):e1-e10.
[54]
Celik SA, Kanan N. A current conflict:use of isotonic sodium chloride solution on endotracheal suctioning in critically ill patients[J]. Dimens Crit Care Nurs, 2006, 25(1):11-14.
[55]
Freytag CC, Thies FL, König W, et al. Prolonged application of closed in-line suction catheters increases microbial colonization of the lower respiratory tract and bacterial growth on catheter surface[J]. Infection, 2003, 31(1):31-37.
[56]
Paratz JD, Stockton KA. Efficacy and safety of normal saline instillation:a systematic review[J]. Physiotherapy, 2009, 95(4):241-250.
[57]
Drew JH, Padoms K, Clabburn SL. Endotracheal tube management in newborn infants with hyaline membrane disease[J]. Aust J Physiother, 1986, 32(1):3-5.
[58]
Singh PK, Tack BF, McCray PB Jr, et al. Synergistic and additive killing by antimicrobial factors found in human airway surface liquid[J]. Am J Physiol Lung Cell Mol Physiol, 2000, 279(5):L799-L805.
[59]
Christensen RD, Henry E, Baer VL, et al. A low-sodium solution for airway care:results of a multicenter trial[J]. Respir Care, 2010, 55(12):1680-1685.
[60]
McKinley DF, Kinney SB, Copnell B, et al. Long-term effects of saline instilled during endotracheal suction in pediatric intensive care:a randomized trial[J]. Am J Crit Care, 2018, 27(6):486-494.
[61]
Morrow BM, Argent AC. A comprehensive review of pediatric endotracheal suctioning:effects, indications, and clinical practice[J]. Pediatr Crit Care Med, 2008, 9(5):465-477.
Gray PH, Flenady VJ, Blackwell L. Potential risks of chest physiotherapy in preterm infants[J]. J Pediatr, 1999, 135(1):131-132.
[70]
Morrow BM. Chest physiotherapy in the pediatric intensive care unit[J]. J Pediatr Intensive Care, 2015, 4(4):174-181.
[71]
Hill S, Engle S, Jorgensen J, et al. Effects of facilitated tucking during routine care of infants born preterm[J]. Pediatr Phys Ther, 2005, 17(2):158-163.
[72]
Anand KJ. Pain, plasticity, and premature birth:a prescription for permanent suffering?[J]. Nat Med, 2000, 6(9):971-973.
[73]
Axelin A, Salanterä S, Lehtonen L, et al. ‘Facilitated tucking by parents’ in pain management of preterm infants-a randomized crossover trial[J]. Early Human Development, 2006, 82(4):241-247.
[74]
Liaw JJ, Yang L, Katherine Wang KW, et al. Non-nutritive sucking and facilitated tucking relieve preterm infant pain during heel-stick procedures:a prospective, randomised controlled crossover trial[J]. Int J Nurs Stud, 2012, 49(3):300-309.
[75]
Ward-Larson C, Horn RA, Gosnell F. The efficacy of facilitated tucking for relieving procedural pain of endotracheal suctioning in very low birthweight infants[J]. MCN Am J Matern Child Nurs, 2004, 29(3):151-158.
[76]
American Association for Respiratory Care. Nasotracheal suctioning-2004 revision & update[J]. Respir Care, 2004, 49(9):1080-1084.
[77]
Siegel JD, Rhinehart E, Jackson M, et al. 2007 guideline for isolation precautions:preventing transmission of infectious agents in health care settings[J]. Am J Infect Control, 2007, 35(10 Suppl 2):S65-S164.
[78]
Shinwell ES. Ultrathin fiberoptic bronchoscopy for airway toilet in neonatal pulmonary atelectasis[J]. Pediatr Pulmonol, 1992, 13(1):48-49.
[79]
Nussbaum E. Pediatric flexible bronchoscopy and its application in infantile atelectasis[J]. Clin Pediatr (Phila), 1985, 24(7):379-382.
[80]
Balfour-Lynn IM, Spencer H. Bronchoscopy-how and when?[J]. Paediatr Respir Rev, 2002, 3(3):255-264.
