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A comprehensive review of pediatric endotracheal suctioning: Effects, indications, and clinical practice*

Morrow, Brenda M. PhD; Argent, Andrew C. FCPaed SA

Pediatric Critical Care Medicine: September 2008 - Volume 9 - Issue 5 - p 465-477
doi: 10.1097/PCC.0b013e31818499cc
Feature Review Article

Objective: To provide a comprehensive, evidence-based review of pediatric endotracheal suctioning: effects, indications, and clinical practice.

Methods: PubMed, Cumulative Index of Nursing and Allied Health Literature, and PEDro (Physiotherapy Evidence Database) electronic databases were searched for English language articles, published between 1962 and June 2007. Owing to the paucity of objective pediatric data, all reports dealing with this topic were examined, including adult and neonatal studies.

Results: One hundred eighteen references were included in the final review. Despite the widespread use of endotracheal suctioning, very little high-level evidence dealing with pediatric endotracheal suctioning exists. Studies of mechanically ventilated neonatal, pediatric, and adult patients have shown that suctioning causes a range of potentially serious complications. Current practice guidelines are not based on evidence from controlled clinical trials. There is no clear evidence that endotracheal suctioning improves respiratory mechanics, with most studies pointing to the detrimental effect it has on lung mechanics. Suctioning should be performed when obstructive secretions are present rather than routinely. There is no clear evidence for the superiority of closed- or open-system suctioning, nor is there clear evidence for appropriate vacuum pressures and suction catheter size. Sterility does not seem to be necessary when suctioning. Preoxygenation has short-term benefits, but the longer-term impact is unknown. Routine saline instillation before suctioning should not be performed. Recruitment maneuvers performed after suctioning have not been shown to be useful as standard practice.

Conclusions: Endotracheal suctioning is a procedure used regularly in the pediatric intensive care unit. Despite this, good evidence supporting its practice is limited. Further, controlled clinical studies are needed to develop evidence-based protocols for endotracheal suctioning of infants and children, and to examine the impact of different suctioning techniques on the duration of ventilatory support, incidence of nosocomial infection, and length of pediatric intensive care unit and hospital stay.

From the Division of Paediatric Critical Care and Children's Heart Disease (BMM, ACA), School of Child and Adolescent Health, University of Cape Town, Cape Town; and Director of Pediatric Intensive Care Unit (ACA), Red Cross War Memorial Children's Hospital, Cape Town, South Africa.

Supported, in part, by the grants from the Medical Research Council of South Africa (BMM) and the Health Sciences Faculty of the University of Cape Town.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: brenda.morrowuct.ac.za

©2008The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies