Tracheal suctioning without disconnection in intubated ventilated neonates

Taylor, Jacqueline E., Hawley, Glenda, Flenady, Vicki and Woodgate, Paul G. (2011) Tracheal suctioning without disconnection in intubated ventilated neonates. Cochrane Database of Systematic Reviews, 12: CD003065.1-CD003065.29. doi:10.1002/14651858.CD003065.pub2

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Author Taylor, Jacqueline E.
Hawley, Glenda
Flenady, Vicki
Woodgate, Paul G.
Title Tracheal suctioning without disconnection in intubated ventilated neonates
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2011
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD003065.pub2
Issue 12
Start page CD003065.1
End page CD003065.29
Total pages 29
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Language eng
Formatted abstract
Background
Assisted mechanical ventilation is a necessity in the neonatal population for a variety of respiratory and surgical conditions. 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 methods
The review has drawn on the search strategy for the Cochrane Neonatal Review Group. A comprehensive search of Cochrane databases, MEDLINE and CINAHL, and the Society for Pediatric Research abstracts was undertaken by the review authors (July 2011).
Selection criteria
All trials that utilised random or quasi-random patient allocation and in which suctioning with or without disconnection from the ventilator was compared.
Data collection and analysis
Standard methods of the Cochrane Neonatal Group were used. Each review author separately reviewed trials for eligibility and quality and extracted data; they then compared and resolved differences. Analysis was performed using the fixed-effect model and outcomes were reported using relative risk (RR) for categorical data and mean difference (MD) for outcomes measured on a continuous scale.
Main results
Four trials (252 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 (typical RR 0.48, CI 95% 0.31 to 0.74; 3 studies; 241 participants). There were also fewer infants who experienced episodes where the transcutaneous partial pressure of oxygen (TcPO2) decreased by > 10% (typical RR 0.39, 95% CI 0.19 to 0.82; 1 study; 11 participants). Suctioning without disconnection resulted in a smaller percentage change in heart rate (weighted mean difference (WMD) 6.77, 95% CI 4.01 to 9.52; 4 studies; 239 participants) and a reduction in the number of infants experiencing a decrease in heart rate by > 10% (typical RR 0.61, CI 0.40 to 0.93; 3 studies; 52 participants).The number of infants having bradycardic episodes was also reduced during closed suctioning (typical RR 0.38, CI 95% 0.15 to 0.92; 3 studies; 241 participants).
Authors' conclusions
There is some evidence to suggest suctioning without disconnection from the ventilator improves the short term outcomes; however the evidence is not strong enough to recommend this practice as the only method of endotracheal suctioning. Future research utilising larger trials needs to address the implications of the different techniques on ventilator associated pneumonia, pulmonary morbidities and neurodevelopment. Infants less than 28 weeks also need to be included in the trials.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Intervention Review # CD003065

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
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Created: Fri, 20 Jul 2012, 11:24:34 EST by Shani Lamb on behalf of Discipline of General Practice