Endotracheal Suctioning of the Critically Ill Child

Abstract

Endotracheal suctioning is an essential intervention for the care of an intubated child and is one of the most commonly performed interventions in pediatric intensive care. Despite this, much of the research related to endotracheal suctioning is dated and the bulk of it conducted in preterm infants and adults. This paper will review research related to endotracheal suctioning that involves or relates to children in intensive care to provide a current review of the literature in this field. It will conclude with recommendations for practice where possible and identify areas for further research.

Keywords

endotracheal suction - suctioning - child - neonate - critically ill - pediatric intensive care

• References

• 1 American Association for Respiratory Care. AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care 2010; 55 (6) 758-764
• 2 Parahoo K. Nursing Research: Principles, Process and Issues. London: Macmillan Press; 1997
• 3 Segar JL, Merrill DC, Chapleau MW, Robillard JE. Hemodynamic changes during endotracheal suctioning are mediated by increased autonomic activity. Pediatr Res 1993; 33 (6) 649-652
• 4 Morrow B, Futter M, Argent A. Effect of endotracheal suction on lung dynamics in mechanically-ventilated paediatric patients. Aust J Physiother 2006; 52 (2) 121-126
• 5 Tingay DG, Copnell B, Grant CA, Dargaville PA, Dunster KR, Schibler A. The effect of endotracheal suction on regional tidal ventilation and end-expiratory lung volume. Intensive Care Med 2010; 36 (5) 888-896
• 6 Fisher DM, Frewen T, Swedlow DB. Increase in intracranial pressure during suctioning—stimulation vs. rise in PaCO2. Anesthesiology 1982; 57 (5) 416-417
• 7 Yano M, Nishiyama H, Yokota H, Kato K, Yamamoto Y, Otsuka T. Effect of lidocaine on ICP response to endotracheal suctioning. Anesthesiology 1986; 64 (5) 651-653
• 8 Tume LN, Baines PB, Lisboa PJ. The effect of nursing interventions on the intracranial pressure in paediatric traumatic brain injury. Nurs Crit Care 2011; 16 (2) 77-84
• 9 Hickey PR, Hansen DD, Wessel DL, Lang P, Jonas RA, Elixson EM. Blunting of stress responses in the pulmonary circulation of infants by fentanyl. Anesth Analg 1985; 64 (12) 1137-1142
• 10 Scoble MK, Copnell B, Taylor A, Kinney S, Shann F. Effect of reusing suction catheters on the occurrence of pneumonia in children. Heart Lung 2001; 30 (3) 225-233
• 11 Morrow BM, Mowzer R, Pitcher R, Argent AC. Investigation into the effect of closed-system suctioning on the frequency of pediatric ventilator-associated pneumonia in a developing country. Pediatr Crit Care Med 2012; 13 (1) e25-e32
• 12 Thomas M, Fothergill-Bourbonnais F. Clinical judgments about endotracheal suctioning: what cues do expert pediatric critical care nurses consider?. Crit Care Nurs Clin North Am 2005; 17 (4) 329-340 , ix
• 13 Davies K, Monterosso L, Leslie G. Determining standard criteria for endotracheal suctioning in the paediatric intensive care patient: an exploratory study. Intensive Crit Care Nurs 2011; 27 (2) 85-93
• 14 Gilbert M. Assessing the need for endotracheal suction. Paediatr Nurs 1999; 11 (1) 14-17
• 15 Copnell B, Fergusson D. Endotracheal suctioning: time-worn ritual or timely intervention?. Am J Crit Care 1995; 4 (2) 100-105
• 16 Swartz K, Noonan DM, Edwards-Beckett J. A national survey of endotracheal suctioning techniques in the pediatric population. Heart Lung 1996; 25 (1) 52-60
• 17 Taylor JE, Hawley G, Flenady V, Woodgate PG. Tracheal suctioning without disconnection in intubated ventilated neonates. Cochrane Database Syst Rev 2011; (12) CD003065
• 18 Kalyn A, Blatz S, , Sandra Feuerstake, Paes B, Bautista C. Closed suctioning of intubated neonates maintains better physiologic stability: a randomized trial. J Perinatol 2003; 23 (3) 218-222
• 19 Paula LC, Ceccon ME. Randomized, comparative analysis between two tracheal suction systems in neonates. Rev Assoc Med Bras 2010; 56 (4) 434-439
• 20 Hoellering AB, Copnell B, Dargaville PA, Mills JF, Morley CJ, Tingay DG. Lung volume and cardiorespiratory changes during open and closed endotracheal suction in ventilated newborn infants. Arch Dis Child Fetal Neonatal Ed 2008; 93 (6) F436-F441
• 21 Choong K, Chatrkaw P, Frndova H, Cox PN. Comparison of loss in lung volume with open versus in-line catheter endotracheal suctioning. Pediatr Crit Care Med 2003; 4 (1) 69-73
• 22 Evans J, Syddall S, Butt W, Kinney S. Comparison of open and closed suction on safety, efficacy and nursing time in a paediatric intensive care unit. Aust Crit Care 2014; 27 (2) 70-74 , quiz 75–76
• 23 Sakuramoto H, Shimojo N, Jesmin S , et al. Repeated open endotracheal suctioning causes gradual desaturation but does not exacerbate lung injury compared to closed endotracheal suctioning in a rabbit model of ARDS. BMC Anesthesiol 2013; 13 (1) 47
• 24 Copnell B, Tingay DG, Kiraly NJ , et al. A comparison of the effectiveness of open and closed endotracheal suction. Intensive Care Med 2007; 33 (9) 1655-1662
• 25 Kiraly NJ, Tingay DG, Mills JF, Morley CJ, Copnell B. Negative tracheal pressure during neonatal endotracheal suction. Pediatr Res 2008; 64 (1) 29-33
• 26 Morrow BM, Futter MJ, Argent AC. Endotracheal suctioning: from principles to practice. Intensive Care Med 2004; 30 (6) 1167-1174
• 27 Kiraly NJ, Tingay DG, Mills JF, Morley CJ, Dargaville PA, Copnell B. The effects of closed endotracheal suction on ventilation during conventional and high-frequency oscillatory ventilation. Pediatr Res 2009; 66 (4) 400-404
• 28 Monaco FJ, Meredith KS. A bench test evaluation of a neonatal closed tracheal suction system. Pediatr Pulmonol 1992; 13 (2) 121-123
• 29 Kiraly NJ, Tingay DG, Mills JF, Dargaville PA, Copnell B. Volume not guaranteed: closed endotracheal suction compromises ventilation in volume-targeted mode. Neonatology 2011; 99 (1) 78-82
• 30 Copnell B, Dargaville PA, Ryan EM , et al. The effect of suction method, catheter size, and suction pressure on lung volume changes during endotracheal suction in piglets. Pediatr Res 2009; 66 (4) 405-410
• 31 Hepponstall JM, Tingay DG, Bhatia R, Loughnan PM, Copnell B. Effect of closed endotracheal tube suction method, catheter size, and post-suction recruitment during high-frequency jet ventilation in an animal model. Pediatr Pulmonol 2012; 47 (8) 749-756
• 32 Singh NC, Kissoon N, Frewen T, Tiffin N. Physiological responses to endotracheal and oral suctioning in paediatric patients: the influence of endotracheal tube sizes and suction pressures. Clin Intensive Care 1991; 2 (6) 345-350
• 33 Boothroyd AE, Murthy BV, Darbyshire A, Petros AJ. Endotracheal suctioning causes right upper lobe collapse in intubated children. Acta Paediatr 1996; 85 (12) 1422-1425
• 34 Feaster SC, West C, Ferketich S. Hyperinflation, hyperventilation, and hyperoxygenation before tracheal suctioning in children requiring long-term respiratory care. Heart Lung 1985; 14 (4) 379-384
• 35 Kerem E, Yatsiv I, Goitein KJ. Effect of endotracheal suctioning on arterial blood gases in children. Intensive Care Med 1990; 16 (2) 95-99
• 36 González-Cabello H, Furuya ME, Vargas MH, Tudón H, Garduño J, González-Ayala J. Evaluation of antihypoxemic maneuvers before tracheal aspiration in mechanically ventilated newborns. Pediatr Pulmonol 2005; 39 (1) 46-50
• 37 Morrow BM, Argent AC. A comprehensive review of pediatric endotracheal suctioning: Effects, indications, and clinical practice. Pediatr Crit Care Med 2008; 9 (5) 465-477
• 38 Gillies D, Spence K. Deep versus shallow suction of endotracheal tubes in ventilated neonates and young infants. Cochrane Database Syst Rev 2011; (7) CD003309
• 39 Ahn Y, Hwang T. The effects of shallow versus deep endotracheal suctioning on the cytological components of respiratory aspirates in high-risk infants. Respiration 2003; 70 (2) 172-178
• 40 Bailey C, Kattwinkel J, Teja K, Buckley T. Shallow versus deep endotracheal suctioning in young rabbits: pathologic effects on the tracheobronchial wall. Pediatrics 1988; 82 (5) 746-751
• 41 Ridling DA, Martin LD, Bratton SL. Endotracheal suctioning with or without instillation of isotonic sodium chloride solution in critically ill children. Am J Crit Care 2003; 12 (3) 212-219
• 42 Beeram MR, Dhanireddy R. Effects of saline instillation during tracheal suction on lung mechanics in newborn infants. J Perinatol 1992; 12 (2) 120-123
• 43 Shorten DR, Byrne PJ, Jones RL. Infant responses to saline instillations and endotracheal suctioning. J Obstet Gynecol Neonatal Nurs 1991; 20 (6) 464-469
• 44 Duff JP, Rosychuk RJ, Joffe AR. The safety and efficacy of sustained inflations as a lung recruitment maneuver in pediatric intensive care unit patients. Intensive Care Med 2007; 33 (10) 1778-1786
• 45 Morrow B, Futter M, Argent A. A recruitment manoeuvre performed after endotracheal suction does not increase dynamic compliance in ventilated paediatric patients: a randomised controlled trial. Aust J Physiother 2007; 53 (3) 163-169