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McKinley DF, Kinney SB, Copnell B, Shann F. Long-Term Effects of Saline Instilled During Endotracheal Suction in Pediatric Intensive Care: A Randomized Trial. Am J Crit Care 2018; 27:486-494. [PMID: 30385540 DOI: 10.4037/ajcc2018615] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Saline instillation is still used to assist in removal of secretions from endotracheal tubes in some pediatric intensive care units. OBJECTIVE To compare the effect of using either no saline, quarter-normal (0.225%) saline, or normal (0.9%) saline during endotracheal suctioning of children receiving ventilatory support in a pediatric intensive care unit. METHOD An unblinded, randomized trial with 3 treatment groups was conducted with 427 children who received ventilatory support for at least 12 hours. Children were randomly assigned to receive no saline, 0.225% saline, or 0.9% saline during routine endotracheal suctioning. RESULTS The primary outcome was the number of hours of invasive mechanical ventilation; oxygen therapy and length of stay in the unit were secondary outcomes. There were 138 children randomly assigned to the no-saline group, 141 to the 0.225% saline group, and 148 to the 0.9% saline group. In Kaplan-Meier intention-to-treat analysis, the median (interquartile range) number of hours of invasive mechanical ventilation was 32 (20-68), 43 (21-86), and 40 (20-87) in the no-saline, 0.225% saline, and 0.9% saline groups, respectively. Although the no-saline group received fewer hours of invasive ventilation, oxygen therapy, and intensive care than the other groups combined, the differences were not statistically significant. CONCLUSION Using no saline was at least as effective as using either 0.225% or 0.9% saline in endotracheal suctioning. The optimal policy may be to routinely use no saline with endotracheal suctioning in children but allow the occasional use of 0.9% saline when secretions are thick.
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Affiliation(s)
- Dianne F. McKinley
- Dianne F. McKinley is a clinical nurse, Intensive Care Unit, Royal Children’s Hospital, Parkville, Victoria, Australia. Sharon B. Kinney is a nurse consultant, Department of Nursing Research, Royal Children’s Hospital; and a senior lecturer, Departments of Nursing and Pediatrics, The University of Melbourne, Victoria. Beverley Copnell is an associate professor, School of Nursing and Midwifery, La Trobe University, Victoria. Frank Shann is a medical doctor, Intensive Care Unit, Royal Children’s Hospital
| | - Sharon B. Kinney
- Dianne F. McKinley is a clinical nurse, Intensive Care Unit, Royal Children’s Hospital, Parkville, Victoria, Australia. Sharon B. Kinney is a nurse consultant, Department of Nursing Research, Royal Children’s Hospital; and a senior lecturer, Departments of Nursing and Pediatrics, The University of Melbourne, Victoria. Beverley Copnell is an associate professor, School of Nursing and Midwifery, La Trobe University, Victoria. Frank Shann is a medical doctor, Intensive Care Unit, Royal Children’s Hospital
| | - Beverley Copnell
- Dianne F. McKinley is a clinical nurse, Intensive Care Unit, Royal Children’s Hospital, Parkville, Victoria, Australia. Sharon B. Kinney is a nurse consultant, Department of Nursing Research, Royal Children’s Hospital; and a senior lecturer, Departments of Nursing and Pediatrics, The University of Melbourne, Victoria. Beverley Copnell is an associate professor, School of Nursing and Midwifery, La Trobe University, Victoria. Frank Shann is a medical doctor, Intensive Care Unit, Royal Children’s Hospital
| | - Frank Shann
- Dianne F. McKinley is a clinical nurse, Intensive Care Unit, Royal Children’s Hospital, Parkville, Victoria, Australia. Sharon B. Kinney is a nurse consultant, Department of Nursing Research, Royal Children’s Hospital; and a senior lecturer, Departments of Nursing and Pediatrics, The University of Melbourne, Victoria. Beverley Copnell is an associate professor, School of Nursing and Midwifery, La Trobe University, Victoria. Frank Shann is a medical doctor, Intensive Care Unit, Royal Children’s Hospital
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