Abstract
identify and analyze in the literature the evidence of randomized controlled trials on care related to the suctioning of endotracheal secretions in intubated, critically ill adult patients undergoing mechanical ventilation. the search was conducted in the PubMed, EMBASE, CENTRAL, CINAHL and LILACS databases. From the 631 citations found, 17 studies were selected. Evidence was identified for six categories of intervention related to endotracheal suctioning, which were analyzed according to outcomes related to hemodynamic and blood gas alterations, microbial colonization, nosocomial infection, and others. although the evidence obtained is relevant to the practice of endotracheal aspiration, the risks of bias found in the studies selected compromise the evidence's reliability.
Highlights
Endotracheal suction is a procedure which aims to keep airways patent by mechanically removing accumulated pulmonary secretions, above all in patients with artificial airways(1).Despite being a necessary procedure, it can lead to complications, such as lesions in the tracheal mucosa, pain, discomfort, infection, alterations of the hemodynamic parameters and of the arterial gases, bronchoconstriction, atelectasis, increase in intra-cranial pressure, and alterations in cerebral blood flow, among others(1-2).Considering this procedure’s complexity, a prior evaluation of the need for suction is indispensable, as this is an invasive, complex procedure that must be undertaken by judicious indication, as it can cause harm to the patient(1,3)
The results of the studies allowed the grouping of evidence into six categories of intervention related to endotracheal suction: research-based endotracheal suction compared to normal endotracheal suction, in one study(8); routine endotracheal suction compared to minimally-invasive endotracheal suction, in two studies(9-10); open system endotracheal suctioning compared to closed system endotracheal suctioning, in eight studies(11-18); change of closed system at 24 compared to 48 hours, in two studies(19-20); daily change of the closed system compared to non-routine change, in one study(21); and saline instillation compared to nonsaline instillation, in three studies(22-24)
Based on the results obtained from this systematic review, the following evidence on endotracheal suction was found: - Research-based endotracheal suction produced the best results for mean arterial pressure, cardiac frequency, partial pressure of oxygen and partial pressure of carbon dioxide, when compared to usual aspiration; - Minimally-invasive endotracheal suction, compared to routine endotracheal aspiration, results in fewer side effects and less memories, in the patient, of having been suctioned; - The closed system of endotracheal suction had better results related to cardiac frequency, arterial pressure, cardiac rhythm, oxygen saturation levels and crosscontamination between the bronchial system and gastric juice, when compared to the open system
Summary
Despite being a necessary procedure, it can lead to complications, such as lesions in the tracheal mucosa, pain, discomfort, infection, alterations of the hemodynamic parameters and of the arterial gases, bronchoconstriction, atelectasis, increase in intra-cranial pressure, and alterations in cerebral blood flow, among others(1-2). Considering this procedure’s complexity, a prior evaluation of the need for suction is indispensable, as this is an invasive, complex procedure that must be undertaken by judicious indication, as it can cause harm to the patient(1,3). It is believed that grouping and synthesizing the available evidence can assist clinical nurses, nurse lecturers and student nurses in incorporating it into their care practice, as well as guiding new research
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