Efficacy and safety of normal saline instillation: A systematic review

Paratz, Jennifer D. and Stockton, Kellie A. (2009) Efficacy and safety of normal saline instillation: A systematic review. Physiotherapy, 95 4: 241-250. doi:10.1016/j.physio.2009.06.002


Author Paratz, Jennifer D.
Stockton, Kellie A.
Title Efficacy and safety of normal saline instillation: A systematic review
Journal name Physiotherapy   Check publisher's open access policy
ISSN 0031-9406
Publication date 2009-12
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/j.physio.2009.06.002
Volume 95
Issue 4
Start page 241
End page 250
Total pages 10
Editor Michele Harms
Place of publication United Kingdom
Publisher Elsevier Ltd
Collection year 2010
Language eng
Subject C1
1106 Human Movement and Sports Science
Formatted abstract
Objective

To investigate the efficacy and safety of the technique of instillation of normal saline prior to suction of airways in intubated patients.

Data sources


Databases searched included: MEDLINE, CINAHL, EMBASE, Cochrane Controlled Trials Register and Full text clinicians’ health journals @ Ovid from the earliest time to March 2009. Citation tracking of relevant primary and review articles.

Review methods


All randomised controlled trials, crossover trials, quasi- and full systematic reviews were screened. From 65 articles screened, 17 articles (two quasi-systematic reviews and 15 empirical studies) met the eligibility criteria and were included for data extraction. The outcomes in the reviewed studies included oxygenation, lung mechanics, sputum yield, dyspnoea, tube patency and ventilator-associated pneumonia. Effect sizes and 95% confidence intervals were calculated.

Results


Studies were mainly of low methodological quality due to factors such as lack of assessor blinding and within-group-only statistics. Overall, there was a positive effect favouring the use of saline to increase sputum yield (d = 0.50, 95% confidence interval 0.10 to 0.90). Due to heterogeneity of methodology, it was not possible to perform meta-analyses on haemodynamics, oxygenation, tube patency and ventilator-associated pneumonia. Overall, while a decrease was found in oxygen saturation measured by pulse oximetry (SpO2) following instillation of normal saline compared with no saline, this was of limited clinical significance.

Conclusions


The results of this review reflect the poor quality of available articles on instillation of normal saline prior to suction of artificial airways. There is little evidence of benefit but also minimal evidence of safety risks. Controlled trials of better quality and more clinically relevant outcomes need to be performed before this technique is either accepted or rejected.
Keyword Physiotherapy
Airway
Sodium chloride
Sputum
Suction
Q-Index Code C1
Q-Index Status Confirmed Code

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: 2010 Higher Education Research Data Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 8 times in Thomson Reuters Web of Science Article | Citations
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Created: Sun, 20 Dec 2009, 00:00:37 EST