Suctioning adults with an artificial airway: a systematic review

Abstract

Objective The objective of this review is to present the best available evidence on interventions designed to reduce the prevalence of complications in hospitalised adult patients who have an artificial airway (endotracheal tube or tracheostomy) and who require suctioning. Criteria for Considering Studies for this Review All studies that related to the objectives of the review were considered for inclusion. This review considered any randomised-controlled trials that addressed the issue of suctioning artificial airways. In the absence of RCTs, other research designs were assessed for inclusion in the narrative summary; to enable the identification of current approaches and possible future strategies for minimising complications associated with suctioning adult hospitalised patients with an artificial airway. Studies that had either spontaneously breathing and/or artificially ventilated subjects were also included. Search Strategy The search aimed to find both published and unpublished information on the practice of suctioning adults with an artificial airway. The Cochrane Controlled Trials Register and the Cochrane Database of Systematic Reviews were searched up to issue 1, 1999. The following databases were also searched. MEDLINE, CINAHL, EMBASE, Current Contents, ABI/INFORM, ERIC, PSYCLIT, The SPORTDiscus Database, SocioFile, Biological Abstracts, HealthSTAR, Index New Zealand and AUSTROM AEI. Date of the most recent searches: May 1999. Assessment and Data Extraction Methodological quality of the studies was assessed independently by several reviewers using a checklist based on the work of the Cochrane Collaboration (1) and Centre for Reviews and Dissemination (2). Assessment of study quality included identifying whether concealment of allocation was adequate, inadequate, or unclear as described in section VI of the Cochrane Collaboration Handbook (1). Additional quality assessments such as blinding of interventions, blinding of outcomes assessment and intention to treat analysis was also included. Disagreements between reviewers were resolved by discussion with an independent reviewer. Data was extracted independently by two reviewers using a data extraction tool. As the studies reviewed were inappropriate for statistical pooling of results, the findings were described in a narrative summary. Main Results The review uncovered a wide variety of research relating to the practice of suctioning adults with an artificial airway. The various designs and the lack of homogeneity in the studies meant that the results could not be combined statistically in a meta-analysis. The studies included in this review have therefore been incorporated into a narrative summary. The methodological flaws in some of the studies presented undermine the validity of their findings. The results must be interpreted accordingly, in light of the strength of the evidence provided. Conclusions Suctioning adults with an artificial airway, although frequently necessary, is not a benign procedure. This review has identified a variety of adverse effects associated with the suctioning procedure. The potential complications and adverse effects of this procedure require that it be undertaken with caution and only once clinical assessment has identified its necessity. The need for close observation of patients, throughout and following the procedure cannot be over stressed, as the adverse effects of suctioning frequently manifest themselves throughout and beyond completion of the procedure.