Efficacy and safety of normal saline instillation and paediatric endotracheal suction: an integrative review

O'Leary, Jessica, Mitchell, Marion L., Cooke, Marie and Schibler, Andreas (2017) Efficacy and safety of normal saline instillation and paediatric endotracheal suction: an integrative review. Australian Critical Care, 31 1: 3-9. doi:10.1016/j.aucc.2017.02.069

Attached Files (Some files may be inaccessible until you login with your UQ eSpace credentials)
Name Description MIMEType Size Downloads

Author O'Leary, Jessica
Mitchell, Marion L.
Cooke, Marie
Schibler, Andreas
Title Efficacy and safety of normal saline instillation and paediatric endotracheal suction: an integrative review
Journal name Australian Critical Care   Check publisher's open access policy
ISSN 1036-7314
1878-1721
Publication date 2017-03-24
Year available 2017
Sub-type Article (original research)
DOI 10.1016/j.aucc.2017.02.069
Open Access Status File (Author Post-print)
Volume 31
Issue 1
Start page 3
End page 9
Total pages 7
Place of publication Philadelphia, PA United States
Publisher Elsevier
Language eng
Abstract To synthesise research findings regarding the efficacy and safety of normal saline instillation (NSI) during endotracheal suction in the paediatric intensive care unit.

The Cochrane Library, PROSPERO, the National Health Service Centre for Reviews and Dissemination, PubMed and Cumulative Index to Nursing and Allied Health (CINAHL) databases were systematically searched. Subject headings included "suctioning, endotracheal", "suction", "sodium chloride", "normal saline" and "paediatrics". Additional references were sourced from hand searches of journal article reference lists and Google Scholar.

An integrative, systematic approach was used to qualitatively synthesise study results in the context of paediatric intensive care nursing practice. Data were extracted using a standardised data extraction form. Quality assessment was performed independently by two reviewers.

Three studies met pre-defined inclusion criteria. Quality of all study methods was 75% on the Mixed Method Appraisal Tool, although reporting quality varied. Overall, there was a scarcity of high quality evidence examining NSI and paediatric endotracheal suction. Outcome measures included oxygen saturation (SpO2), serious adverse events (author/s defined) and ventilation parameters (author/s defined). Endotracheal suction with NSI was associated with a transient decrease in blood oxygen saturation; research protocols did not include interventions to mitigate alveolar derecruitment. Studies were not powered to detect differences in endotracheal tube (ETT) occlusion or ventilator associated pneumonia (VAP).

NSI was associated with a transient decrease in oxygen saturation. In children with obstructive mucous, NSI may have a positive effect. Practices which maximise secretion removal and mitigate the negative physiological interactions of ETS have been poorly evaluated in the paediatric population. High quality, powered, clinical trials are needed to determine the safety and efficacy of normal saline instillation and to inform clinical practice.
Formatted abstract
Objective

To synthesise research findings regarding the efficacy and safety of normal saline instillation (NSI) during endotracheal suction in the paediatric intensive care unit.

Data sources

The Cochrane Library, PROSPERO, the National Health Service Centre for Reviews and Dissemination, PubMed and Cumulative Index to Nursing and Allied Health (CINAHL) databases were systematically searched. Subject headings included “suctioning, endotracheal”, “suction”, “sodium chloride”, “normal saline” and “paediatrics”. Additional references were sourced from hand searches of journal article reference lists and Google Scholar.
Method

An integrative, systematic approach was used to qualitatively synthesise study results in the context of paediatric intensive care nursing practice. Data were extracted using a standardised data extraction form. Quality assessment was performed independently by two reviewers.

Results

Three studies met pre-defined inclusion criteria. Quality of all study methods was 75% on the Mixed Method Appraisal Tool, although reporting quality varied. Overall, there was a scarcity of high quality evidence examining NSI and paediatric endotracheal suction. Outcome measures included oxygen saturation (SpO2), serious adverse events (author/s defined) and ventilation parameters (author/s defined). Endotracheal suction with NSI was associated with a transient decrease in blood oxygen saturation; research protocols did not include interventions to mitigate alveolar derecruitment. Studies were not powered to detect differences in endotracheal tube (ETT) occlusion or ventilator associated pneumonia (VAP).

Conclusion

NSI was associated with a transient decrease in oxygen saturation. In children with obstructive mucous, NSI may have a positive effect. Practices which maximise secretion removal and mitigate the negative physiological interactions of ETS have been poorly evaluated in the paediatric population. High quality, powered, clinical trials are needed to determine the safety and efficacy of normal saline instillation and to inform clinical practice.
Keyword Paediatric intensive care
Endotracheal suction
Normal saline instillation
Nursing
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Clinical Medicine Publications
Admin Only - School of Clinical Medicine
 
Versions
Version Filter Type
Citation counts: Scopus Citation Count Cited 0 times in Scopus Article
Google Scholar Search Google Scholar
Created: Tue, 26 Sep 2017, 00:15:25 EST by Web Cron on behalf of Faculty of Medicine