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Yılmaz İ, Özden D. The effects of open and closed system endotracheal suctioning methods on suctioning frequency, amount of secretion, and haemodynamics: A single-blind, randomised, 2 × 2 crossover trial. Aust Crit Care 2024; 37:25-33. [PMID: 37833132 DOI: 10.1016/j.aucc.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Several studies have revealed that clinicians cannot suction all available secretion in the trachea and perform more frequent suctioning with a closed suctioning system (CSS) than with an open suctioning system (OSS). There are also studies claiming that the CSS is as effective as the OSS, based on either the amount of secretion, the frequency of suctioning, or haemodynamic parameters alone. However, there is no study examining all at once. OBJECTIVES This study aims to determine whether the CSS is as effective for secretion removal, suctioning frequency, tidal volume (VT), and peripheral oxygen saturation (SpO2) as the OSS. METHODS The study used a single-blind, randomised, 2 × 2 crossover (2-method, 2-arm, 2-period) design. One hundred intubated patients were randomly assigned to two study arms. Thirty-four were randomised to the CSS on the first day and the OSS on the second day (AB arm), and 35 were randomised to the OSS on the first day and the CSS on the second day (BA arm). A 12-h washout period was set between them. Haemodynamic parameters were measured just before suctioning and in the 5th minute after suctioning. The secretions obtained after suctioning were weighed, and the frequency of suctioning was recorded. RESULTS There were no effects of method, period, or carryover on suctioning frequency and amount of secretion in the 2 × 2 crossover design t-test (p > 0.05). In the OSS, there was a weak, linear, and negative correlation between the amount of secretion and SpO2, and between VT and SpO2 measured before and after suctioning (p < 0.05 for all). CONCLUSIONS Open and closed suctioning systems were similar in terms of haemodynamic alterations, amounts of secretion, and frequency of suctioning. The CSS was as effective as the OSS. REGISTRATION NUMBER NCT04053751.
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Affiliation(s)
- İlkin Yılmaz
- Dokuz Eylül University Faculty of Nursing, 35340, Izmir, Turkey.
| | - Dilek Özden
- Dokuz Eylül University Faculty of Nursing, 35340, Izmir, Turkey
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The Paediatric AirWay Suction (PAWS) appropriateness guide for endotracheal suction interventions. Aust Crit Care 2021; 35:651-660. [PMID: 34953635 DOI: 10.1016/j.aucc.2021.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/10/2021] [Accepted: 10/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/OBJECTIVE Endotracheal suction is an invasive and potentially harmful technique used for airway clearance in mechanically ventilated children. Choice of suction intervention remains a complex and variable process. We sought to develop appropriate use criteria for endotracheal suction interventions used in paediatric populations. METHODS The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop the Paediatric AirWay Suction appropriateness guide. This included defining key terms, synthesising current evidence, engaging an expert multidisciplinary panel, case scenario development, and two rounds of appropriateness ratings (weighing harm with benefit). Indications (clinical scenarios) were developed from common applications or anticipated use, current practice guidelines, clinical trial results, and expert consultation. RESULTS Overall, 148 (19%) scenarios were rated as appropriate (benefit outweighs harm), 542 (67%) as uncertain, and 94 (11%) as inappropriate (harm outweighs benefit). Disagreement occurred in 24 (3%) clinical scenarios, namely presuction and postsuction bagging across populations and age groups. In general, the use of closed suction was rated as appropriate, particularly in the subspecialty population 'patients with highly infectious respiratory disease'. Routine application of 0.9% saline for nonrespiratory indications was more likely to be inappropriate/uncertain than appropriate. Panellists preferred clinically indicated suction versus routine suction in most circumstances. CONCLUSION Appropriate use criteria for endotracheal suction in the paediatric intensive care have the potential to impact clinical decision-making, reduce practice variability, and improve patient outcomes. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research.
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Schults JA, Charles K, Long D, Erikson S, Brown G, Waak M, Tume L, Hall L, Ullman AJ. Appropriate use criteria for endotracheal suction interventions in mechanically ventilated children: The RAND/UCLA development process. Aust Crit Care 2021; 35:661-667. [PMID: 34924248 DOI: 10.1016/j.aucc.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/10/2021] [Accepted: 10/17/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Endotracheal suction is an invasive airway clearance technique used in mechanically ventilated children. This article outlines the methods used to develop appropriate use criteria for endotracheal suction interventions in mechanically ventilated paediatric patients. METHODS The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop paediatric appropriate use criteria. This included the following sequential phases of defining scope and key terms, a literature review and synthesis, expert multidisciplinary panel selection, case scenario development, and appropriateness ratings by an interdisciplinary expert panel over two rounds. The panel comprised experts in the fields of paediatric and neonatal intensive care, respiratory medicine, infectious diseases, critical care nursing, implementation science, retrieval medicine, and education. Case scenarios were developed iteratively by interdisciplinary experts and derived from common applications or anticipated intervention uses, as well as from current clinical practice guidelines and results of studies examining interventions efficacy and safety. Scenarios were rated on a scale of 1 (harm outweighs benefit) to 9 (benefit outweighs harm), to define appropriate use (median: 7 to 9), uncertain use (median: 4 to 6), and inappropriate use (median: 1 to 3) of endotracheal suction interventions. Scenarios were than classified as a level of appropriateness. CONCLUSIONS The RAND Corporation/University of California, Los Angeles Appropriateness Method provides a thorough and transparent method to inform development of the first appropriate use criteria for endotracheal suction interventions in paediatric patients.
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Affiliation(s)
- Jessica A Schults
- Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Metro North Hospital and Health Service, Queensland, Australia; Child Health Research Centre, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia.
| | - Karina Charles
- Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
| | - Debbie Long
- Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Simon Erikson
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Georgia Brown
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Michaela Waak
- Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia; Child Health Research Centre, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Lyvonne Tume
- School of Health & Society, University of Salford, Manchester UK; Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool UK
| | - Lisa Hall
- School of Public Health, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Amanda J Ullman
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Child Health Research Centre, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia; Queensland Children's Hospital, Queensland, Australia
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babaie S, torki A, Keivanfar M. Efficacy of fentanyl on pain relief during tracheal suctioning in ventilated children: A randomized clinical trial. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schults JA, Cooke M, Long D, Schibler A, Ware RS, Charles K, Irwin A, Mitchell ML. Normal saline and lung recruitment with paediatric endotracheal suction (NARES): A pilot, factorial, randomised controlled trial. Aust Crit Care 2021; 34:530-538. [PMID: 34052092 DOI: 10.1016/j.aucc.2021.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/17/2021] [Accepted: 01/23/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/OBJECTIVE Endotracheal suction is one of the most common and harmful procuedres performed on mechanically ventilated children. The aim of the study was to establish the feasibility of a randomised controlled trial (RCT) examining the effectiveness of normal saline instillation (NSI) and a positive end-expiratory pressure recruitment manoeuvre (RM) with endotracheal suction in the paediatric intensive care unit. METHODS Pilot 2 × 2 factorial RCT. The study was conducted at a 36-bed tertiary paediatric intensive care unit in Australia. Fifty-eight children aged less than 16 years undergoing tracheal intubation and invasive mechanical ventilation. (i) NSI or no NSI and (ii) RM or no RM with endotracheal suction . The primary outcome was feasibility; secondary outcomes were ventilator-associated pneumonia (VAP), change in end-expiratory lung volume assessed by electrical impedance tomography, dynamic compliance, and oxygen saturation-to-fraction of inspired oxygen (SpO2/FiO2) ratio. RESULTS/FINDINGS Recruitment, retention, and missing data feasibility criteria were achieved. Eligibility and protocol adherence criteria were not achieved, with 818 patients eligible and 58 enrolled; cardiac surgery was the primary reason for exclusion. Approximately 30% of patients had at least one episode of nonadherence. Children who received NSI had a reduced incidence of VAP; however, this did not reach statistical significance (incidence rate ratio = 0.12, 95% confidence interval = 0.01-1.10; p = 0.06). NSI was associated with a significantly reduced SpO2/FiO2 ratio up to 10 min after suction. RMs were not associated with a reduced VAP incidence (incidence rate ratio = 0.31, 95% confidence interval = 0.05-1.88), but did significantly improve end-expiratory lung volume at 2 and 5 min after suction, dynamic compliance, and SpO2/FiO2 ratio. CONCLUSION RMs provided short-term improvements in end-expiratory lung volume and oxygenation. NSI with suction led to a reduced incidence of VAP; however, a definitive RCT is needed to test statistical differences. A RCT of study interventions is worthwhile and may be feasible with protocol modifications including the widening of participant eligibility.
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Affiliation(s)
- Jessica A Schults
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Critical Care Research Group, Centre for Children's Health Research, The University of Queensland, South Brisbane, Queensland, Australia.
| | - Marie Cooke
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Debbie Long
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Critical Care Research Group, Centre for Children's Health Research, The University of Queensland, South Brisbane, Queensland, Australia
| | - Andreas Schibler
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia; Paediatric Critical Care Research Group, Centre for Children's Health Research, The University of Queensland, South Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Karina Charles
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Adam Irwin
- UQ Centre for Clinical Research, The University of Queensland, Australia; Infection Management and Prevention Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Marion L Mitchell
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia
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Schults JA, Long DA, Mitchell ML, Cooke M, Gibbons K, Pearson K, Schibler A. Adverse events and practice variability associated with paediatric endotracheal suction: An observational study. Aust Crit Care 2019; 33:350-357. [PMID: 31748181 DOI: 10.1016/j.aucc.2019.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/12/2019] [Accepted: 08/20/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine the incidence of endotracheal tube (ETT) suction-related adverse events (AEs) and to examine associations between AEs and patient and suction characteristics. Secondary objectives were to describe ETT suction practices in an Australian paediatric intensive care unit (PICU). METHODS A prospective, observational study was undertaken in a mixed cardiac and general PICU. Children were eligible for inclusion if they were intubated and mechanically ventilated. Data on patient and suction variables (indication for ETT suction, number of suction episodes per mechanical ventilation episode, indication for normal saline instillation [NSI] and NSI dose) including potential predictive variables (age, Paediatric Index of Mortality 3 [PIM3], NSI, positive end-expiratory pressure, and hyperoxygenation) were collected. The main outcome variable was a composite measure of any AE. MAIN RESULTS A total of 955 suction episodes were recorded in 100 children. AEs occurred in 211 (22%) ETT suctions. Suction-related AEs were not associated with age, diagnostic category, or index of mortality score. Desaturation was the most common AE (180 suctions; 19%), with 69% of desaturation events requiring clinician intervention. Univariate logistic regression showed the odds of desaturation decreased as the internal diameter of the ETT increased (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.37-0.95; p = 0.028). Multivariable modelling revealed NSI was significantly associated with an increased risk of desaturation (adjusted OR [aOR]: 3.23; 95% CI: 1.99-5.40; p < 0.001) and the occurrence of an AE (aOR: 2.76; 95% CI: 1.74-4.37; p < 0.001). Presuction increases in fraction of inspired oxygen (FiO2) was significantly associated with an increased risk of experiencing an AE (aOR: 2.0; 95% CI: 1.27-3.15; p = 0.003). CONCLUSIONS ETT suction-related AEs are common and associated with NSI and the requirement for pre-suction increases in FiO2. Clinical trial data are needed to identify high-risk patient groups and to develop interventions which optimise practice and reduce the occurrence of ETT suction-related AEs.
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Affiliation(s)
- Jessica A Schults
- Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia.
| | - Debbie A Long
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Queensland, Australia
| | - Marion L Mitchell
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia
| | - Marie Cooke
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Kristen Gibbons
- Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia
| | - Kylie Pearson
- Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Queensland, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Queensland, Australia; School of Medicine, The University of Queensland, Queensland, Australia
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Endotracheal Lidocaine Installation, Endotracheal Suction, and Intracranial Pressure in Patients With Traumatic Brain Injury-Assessing the Impact. Pediatr Crit Care Med 2019; 20:387-388. [PMID: 30950993 DOI: 10.1097/pcc.0000000000001848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gilder E, Parke RL, Jull A. Endotracheal suction in intensive care: A point prevalence study of current practice in New Zealand and Australia. Aust Crit Care 2019; 32:112-115. [DOI: 10.1016/j.aucc.2018.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/19/2018] [Accepted: 03/01/2018] [Indexed: 11/15/2022] Open
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Davies K, Bulsara MK, Ramelet AS, Monterosso L. Reliability and criterion-related validity testing (construct) of the Endotracheal Suction Assessment Tool (ESAT©). J Clin Nurs 2018; 27:1891-1900. [PMID: 29345013 DOI: 10.1111/jocn.14269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2018] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To establish criterion-related construct validity and test-retest reliability for the Endotracheal Suction Assessment Tool© (ESAT©). BACKGROUND Endotracheal tube suction performed in children can significantly affect clinical stability. Previously identified clinical indicators for endotracheal tube suction were used as criteria when designing the ESAT©. Content validity was reported previously. The final stages of psychometric testing are presented. DESIGN Observational testing was used to measure construct validity and determine whether the ESAT© could guide "inexperienced" paediatric intensive care nurses' decision-making regarding endotracheal tube suction. Test-retest reliability of the ESAT© was performed at two time points. METHODS The researchers and paediatric intensive care nurse "experts" developed 10 hypothetical clinical scenarios with predetermined endotracheal tube suction outcomes. "Experienced" (n = 12) and "inexperienced" (n = 14) paediatric intensive care nurses were presented with the scenarios and the ESAT© guiding decision-making about whether to perform endotracheal tube suction for each scenario. Outcomes were compared with those predetermined by the "experts" (n = 9). Test-retest reliability of the ESAT© was measured at two consecutive time points (4 weeks apart) with "experienced" and "inexperienced" paediatric intensive care nurses using the same scenarios and tool to guide decision-making. RESULTS No differences were observed between endotracheal tube suction decisions made by "experts" (n = 9), "inexperienced" (n = 14) and "experienced" (n = 12) nurses confirming the tool's construct validity. No differences were observed between groups for endotracheal tube suction decisions at T1 and T2. CONCLUSION Criterion-related construct validity and test-retest reliability of the ESAT© were demonstrated. Further testing is recommended to confirm reliability in the clinical setting with the "inexperienced" nurse to guide decision-making related to endotracheal tube suction. RELEVANCE TO CLINICAL PRACTICE The ESAT© is the first validated tool to systematically guide endotracheal nursing practice for the "inexperienced" nurse.
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Affiliation(s)
- Kylie Davies
- University of Notre Dame Australia, Fremantle, WA, Australia.,Paediatric Intensive Care Unit, Princess Margaret Hospital for Children, Subiaco, WA, Australia
| | - Max K Bulsara
- School of Population Health, Institute of Health and Rehabilitation Research, University of Notre Dame Australia, Fremantle, WA, Australia.,School of Population Health, University of Western Australia, Crawley, WA, Australia.,University College London, London, UK
| | - Anne-Sylvie Ramelet
- Faculty of Biology and Medicine, Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Leanne Monterosso
- School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, WA, Australia.,St John of God Murdoch Hospital, Murdoch, WA, Australia.,School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
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Schults JA, Cooke M, Long D, Mitchell ML. "When no-one's looking," the application of lung recruitment and normal saline instillation with paediatric endotracheal suction: An exploratory study of nursing practice. Aust Crit Care 2018; 32:13-19. [PMID: 29752213 DOI: 10.1016/j.aucc.2018.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The complex nature of the Paediatric Intensive Care Unit (PICU) patient requires the bedside nurse to make rapid, complex decisions regarding endotracheal suction (ETS) interventions. It is not understood what influences nurses' decision making in the context of ETS, however, the actions of the clinician have a direct impact on the efficacy of the ETS event and patient outcomes. OBJECTIVES To explore and describe the use of normal saline instillation and lung recruitment with paediatric ETS in a cohort of Australian nurses, and to identify factors that influence normal saline use with ETS. METHODS A descriptive, exploratory study. An evidence-based practice model formed the conceptual basis for the study. Semi-structured interviews were conducted with 12 nurses from an Australian tertiary referral paediatric intensive care unit. Audiotaped interviews were transcribed. Inductive thematic analysis was used to code and analyse the interview data and identify themes. FINDINGS Data analysis revealed three themes: patient's clinical presentation, clinician judgement and unit practice norms. CONCLUSIONS Variability in nurses ETS practice was marked. In the absence of evidence based clinical guidelines, nurses relied on knowledge derived from clinical experience and the local setting to guide NSI and LR intervention decisions. Participants reported uncertainty regarding ETS best practice and perceived the lack of research evidence as a barrier to making informed clinical decisions at the bedside. Rigorous research evaluating the safety and efficacy of NSI and LR with ETS is urgently required for patient care; however PICU nurses rely on multiple sources of evidence to inform ETS practice decision.
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Affiliation(s)
- Jessica A Schults
- Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia; Menzies Health Institute, Griffith University, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Critical Care Research Group, Lady Cilento Children's Hospital, Queensland, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Queensland, Australia.
| | - Marie Cooke
- Menzies Health Institute, Griffith University, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia.
| | - Debbie Long
- Menzies Health Institute, Griffith University, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Critical Care Research Group, Lady Cilento Children's Hospital, Queensland, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Queensland, Australia.
| | - Marion L Mitchell
- Menzies Health Institute, Griffith University, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia.
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Schults JA, Cooke M, Long DA, Schibler A, Ware RS, Mitchell ML. Normal saline instillation versus no normal saline instillation And lung Recruitment versus no lung recruitment with paediatric Endotracheal Suction: the NARES trial. A study protocol for a pilot, factorial randomised controlled trial. BMJ Open 2018; 8:e019789. [PMID: 29391372 PMCID: PMC5878246 DOI: 10.1136/bmjopen-2017-019789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Endotracheal suction (ETS) is a frequent and necessary airway intervention for the intubated child. The aim of ETS is to clear the endotracheal tube and airways of respiratory secretions; however, the methods of performing ETS are varied. Internationally a number of ETS treatments are in use. Many have not been rigorously evaluated in a randomised controlled trial setting, and it is uncertain whether any are associated with better outcomes for the critically ill child. With approximately 50% of paediatric intensive care admissions requiring intubation, ETS interventions that maximise the efficacy and minimise the complications of ETS could translate to improved health for substantial numbers of critically ill children, and significant cost savings. The primary aim of the study is to examine two ETS interventions, normal saline instillation and lung recruitment, to determine if it is feasible to conduct a full efficacy trial. METHODS AND ANALYSIS NARES (Normal saline instillation versus no normal saline instillation And lung Recruitment versus no lung recruitment with paediatric Endotracheal Suction) is a single-centre, pilot, factorial randomised controlled trial conducted in a tertiary referral paediatric centre in Brisbane, Australia. Children (aged 0-16 years) are eligible if they are intubated with an endotracheal tube and mechanically ventilated. Two intervention pairs will be compared using a 2×2 factorial design: (1) normal saline instillation versus no normal saline instillation; and (2) lung recruitment versus no lung recruitment. The primary outcome is study feasibility measured by a composite analysis of eligibility, recruitment, retention, protocol adherence and missing data. Secondary outcomes are ventilator-associated pneumonia, SpO2/FiO2 ratio, lung compliance, end expiratory level and regional tidal volume. ETHICS AND DISSEMINATION Ethical approval to conduct the research has been obtained. Dissemination of the research findings will be untaken, guided by the Consolidated Standards of Reporting Trials statement recommendations. Protocol content was guided by the Standard Protocol Items: Recommendations for Interventional Trials 2013 statement. TRIAL REGISTRATION NUMBER ACTRN12617000609358; Pre-results.
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Affiliation(s)
- Jessica A Schults
- Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
- Paediatric Critical Care Research Group, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Marie Cooke
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Debbie A Long
- Paediatric Critical Care Research Group, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Marion L Mitchell
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Content validity testing of the ESAT © : A decision aid tool for performing endotracheal suction in children. Aust Crit Care 2018; 31:23-30. [DOI: 10.1016/j.aucc.2017.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/12/2017] [Accepted: 01/23/2017] [Indexed: 11/30/2022] Open
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Chiang J, Amin R. Respiratory Care Considerations for Children with Medical Complexity. CHILDREN-BASEL 2017; 4:children4050041. [PMID: 28534851 PMCID: PMC5447999 DOI: 10.3390/children4050041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/08/2017] [Accepted: 05/16/2017] [Indexed: 12/13/2022]
Abstract
Children with medical complexity (CMC) are a growing population of diagnostically heterogeneous children characterized by chronic conditions affecting multiple organ systems, the use of medical technology at home as well as intensive healthcare service utilization. Many of these children will experience either a respiratory-related complication and/or they will become established on respiratory technology at home during their care trajectory. Therefore, healthcare providers need to be familiar with the respiratory related complications commonly experienced by CMC as well as the indications, technical and safety considerations and potential complications that may arise when caring for CMC using respiratory technology at home. This review will outline the most common respiratory disease manifestations experienced by CMC, and discuss various respiratory-related treatment options that can be considered, including tracheostomy, invasive and non-invasive ventilation, as well as airway clearance techniques. The caregiver requirements associated with caring for CMC using respiratory technology at home will also be reviewed.
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Affiliation(s)
- Jackie Chiang
- Holland Bloorview Kids Rehabilitation Hospital, The University of Toronto, Toronto, ON M4G 1R8, Canada.
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, The University of Toronto, Toronto, ON M5G 1X8, Canada.
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Davies K, Bulsara MK, Ramelet AS, Monterosso L. Audit of Endotracheal Tube Suction in a Pediatric Intensive Care Unit. Clin Nurs Res 2016; 26:68-81. [PMID: 26254167 DOI: 10.1177/1054773815598272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report outcomes of a clinical audit examining criteria used in clinical practice to rationalize endotracheal tube (ETT) suction, and the extent these matched criteria in the Endotracheal Suction Assessment Tool(ESAT)©. A retrospective audit of patient notes ( N = 292) and analyses of criteria documented by pediatric intensive care nurses to rationalize ETT suction were undertaken. The median number of documented respiratory and ventilation status criteria per ETT suction event that matched the ESAT© criteria was 2 [Interquartile Range (IQR) 1-6]. All criteria listed within the ESAT© were documented within the reviewed notes. A direct link was established between criteria used for current clinical practice of ETT suction and the ESAT©. The ESAT©, therefore, reflects documented clinical decision making and could be used as both a clinical and educational guide for inexperienced pediatric critical care nurses. Modification to the ESAT
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Affiliation(s)
- Kylie Davies
- 1 Princess Margaret Hospital for Children, Perth, Australia
| | - Max K Bulsara
- 2 The University of Notre Dame, Fremantle, Australia
| | | | - Leanne Monterosso
- 2 The University of Notre Dame, Fremantle, Australia.,4 St. John of God Murdoch Hospital, Murdoch, Australia
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