Endotracheal Suctioning Research Articles

Wearable smart glasses for first‐person video analysis to evaluate nursing skills: A pilot study with a mixed method design

AbstractBackgroundComprehensive assessment of skills and performance are necessary to improve the quality of care in nursing education. Various factors pose challenges to accurate assessments, including high student–teacher ratio and observer bias.ObjectivesTo establish an assessment system based on first‐person video of smart glasses and validate its usability and feasibility.MethodsWe used two cameras (smart glasses for first‐person perspective and a web cam) to perform video analysis for skill and performance assessments. Usability tests were conducted using quantitative and qualitative questionnaires for the usefulness and acceptability of the current assessment system. Data from standardised checklists for three clinical nursing skills (intramuscular injection, endotracheal suction, and Levin tube feeding) were used to analyse the inter‐rater reliability in addition to Fleiss' Kappa coefficient analysis. A total of 22 participants (18 students and 4 reviewers) were recruited. They completed the study. Apart from physical discomfort component, the proposed smart glasses‐based first‐person video assessment system achieved good usability scores from both students and reviewers.Results and ConclusionsFleiss' Kappa values for individual items ranged from 0.450 to 0.808, with an overall average value of 0.592. Results of this study validated the potential of smart glasses‐based assessment system where a set of beneficial mechanisms may meaningfully support the formative learning process. However, issues regarding upgrading the device and need for guidelines for roles of raters and students still remain.

Validity and reliability of the Endotracheal Suction Assessment Tool© in adult ICU patients: A methodological study

BackgroundNovice nurses often find endotracheal suctioning signs unfamiliar. The Endotracheal Suction Assessment Tool© (ESAT©) aids pediatric nurses in suctioning but lacks an adult equivalent. A valid and reliable ESAT© for assessing intensive care unit patients’ suction needs across different populations is necessary. AimTo test the validity and reliability of the ESAT© in adult ICU patients. MethodsThis methodological study assessed suction needs in patients at a tertiary adult ICU of a university hospital. Two independent observers used the ESAT© to determine suction needs. Data from 106 suction procedures were collected using a patient characteristics form, the ESAT©, and a suction monitoring form. The ESAT© includes eight respiratory and ventilation parameters and seven clinical consideration parameters. Hemodynamic and respiratory parameters were measured before, and one and five minutes after suction. Linguistic validity, content validity, and pilot testing were conducted. Interobserver agreement was evaluated, and psychometric evaluation was done using content validity index (CVI) and intraclass correlation coefficient (ICC). Data were analyzed with paired samples t-test and ANOVA. ResultsItem CVI ranged from 0.80 to 1.00, and scale CVI was 0.96. Inter-item correlation and ICC for inter-rater reliability were both 0.933 (95 % CI = 0.903–0.954, p < 0.001 for ICC). Cohen’s Kappa coefficients ranged from 0.690 to 1.000 (p < 0.001), indicating high consistency between raters for all tool items. All scale items showed near-perfect agreement except SpO2, which showed substantial agreement. ConclusionThe S-CVI was good, indicating near-perfect agreement among raters. ESAT© is highly reliable and valid for determining suction needs in adult intensive care patients. Implications for PracticeThe ESAT© aids autonomous decision-making for suctioning needs. Originally for novice pediatric nurses, the ESAT© was adapted for adult intensive care nurses. The ESAT© is valid and reliable for adult intensive care patients.

The effectiveness of hyperoxygenation in preventing oxygen desaturation in intubated infants treated with endotracheal suctioning

Endotracheal suctioning is an effective nursing intervention for intubated infants undergoing invasive mechanical ventilation. However, this intervention has the potential to cause side effects, such as hypoxemia, which typically requires hyperoxygenation. Despite the widespread use of hyperoxygenation in clinical practice, there are limited reports on its effectiveness in infants. This study aims to determine the effect of hyperoxygenation on oxygen saturation of intubated infants.The study procedures were carried out using a quasi-experimental method with a cross-over approach. In addition, the sample population comprised 22 intubated infants who were treated at the perinatology unit of Dr. Cipto Mangunkusumo Hospital in Jakarta from March to April 2018. The participants were then divided into 2 groups based on their condition, and oxygen saturation level was assessed. The intervention comprised endotracheal suctioning with and without hyperoxygenation, with a 3-hour washing period. Data collection was performed at different measurement intervals, namely before, during, and after suctioning, followed by statistical analysis.The paired-sample t-tests and Wilcoxon test showed that there was a significant difference in oxygen saturation at certain measurement intervals (p=0.006; p=0.010; p=0.001; p=0.001; p=0.001). In addition, Friedman test also showed the presence of a significant difference in the reduction of oxygen saturation between the control and intervention groups (p=0.001).In conclusion, hyperoxygenation had the potential to prevent the reduction of oxygen saturation during endotracheal suctioning in intubated infants. However, individual assessment of the need for suctioning and hyperoxygenation was necessary for a safe and effective procedure.

Intensive Care Nurses' Performance of Open versus Closed Endotracheal Suction on Critically Ill Patients in Ismailia City.

Endotracheal Tube Suctioning (ETS), which involves either an open or closed suctioning system, is a crucial practice for mechanically ventilated patients. The nursing practice of airway suctioning is inevitable. This study was designed to compare the intensive care nurses' performance of open versus closed endotracheal suction on critically ill patients in Ismailia City. A non-participant structured observational study design was conducted on a convenient sample (N = 63) at intensive care units at a teaching hospital through March and August 2022 to evaluate how nurses practice different procedures in open suctioning compared with the closed suctioning system of Endotracheal Suction (ES) through a 32-item structured checklist. Additionally, authors compared their levels of knowledge in both suctioning systems. Approximately 75% and 65% of the study participants had a satisfactory level of knowledge about the open system compared with the closed system, respectively. The total percentage of patients who achieved a satisfactory level of practice was 72% for the open-system group, compared with 56% for the closed-system group. Overall, there were significant differences between total nurses' performances in the open-system and closed-system systems. Independent sample t-tests revealed a statistically significant correlation between overall nurses' performance in both systems (t = 6.04, p < 0.001). The findings revealed significant differences in nurses' performance between open and closed-system suctioning. The researchers recommend in-service-led training programs to improve nurses' performance, and other studies with larger sample sizes should be supported.

The Effect of Swaddling and Oropharyngeal Colostrum During Endotracheal Suctioning on Procedural Pain and Comfort in Premature Neonates: A Randomized Controlled Trial.

Endotracheal suctioning (ES) is a painful procedure frequently performed in the neonatal intensive care unit. This procedure negatively affects the comfort level of premature neonates. To determine the effect of 2 nonpharmacologic methods, swaddling and the administration of oropharyngeal colostrum, on the pain and comfort levels of preterm neonates during ES. This randomized controlled experimental study comprised 48 intubated premature neonates (swaddling group n =16; oropharyngeal colostrum group n =16; and control group n =16) at 26 to 37weeks of gestation. The neonates were swaddled with a white soft cotton cloth or administered 0.4 mL of oropharyngeal colostrum 2minutes before ES, according to the group in which they were included. Two observers evaluated the pain levels (Premature Infant Pain Profile-Revize [PIPP-R]) and comfort (Newborn Comfort Behavior Scale [COMFORTneo]) of the infants by observing video recordings of before, during, and after the procedure. A significantly lower mean PIPP-R score was found in the swaddling group during ES compared with the control group ( P =.002). The mean COMFORTneo scores of the swaddling and oropharyngeal colostrum groups during ES ( P <.01, P =.002) and the mean PIPP-R and COMFORTneo scores immediately after ES and 5, 10, and 15minutes later were significantly lower than the control group ( P <.005). Swaddling was effective both during and after the procedure, while oropharyngeal colostrum was effective only after the procedure in reducing ES-related pain in premature neonates. Swaddling and oropharyngeal colostrum were effective in increasing comfort both during and after the procedure.

Effects of endotracheal suctioning duration cerebral oxygenation in preterm infants.

This study evaluates the effects of endotracheal suctioning duration on cerebral oxygenation and physiological parameters in preterm infants in intensive care. Prospective and observational s tudy. In this study, 51 preterm infants born at 28-34 weeks of gestation in NICU were evaluated. Cerebral oxygenation was measured before, during, and after endotracheal suctioning with near-infrared spectroscopy. Pain levels of the infants were with N-PASS scale. A negative correlation was found between the lowest cerebral oxygenation value during endotracheal suctioning and the duration of endotracheal suctioning. Cerebral oxygenation levels during endotracheal suctioning were lower than pre- and post-endotracheal suctioning levels. Higher cerebral oxygenation was observed in infants whose endotracheal aspiration time was less than 13 s. The duration of endotracheal suctioning was positively correlated with pain and cerebral oxygenation stabilization time. Prolonged endotracheal suctioning duration negatively affects cerebral oxygenation in preterm infants. The study suggests an optimal endotracheal suctioning duration under 13 s. Properly executed endotracheal suctioning, with the correct technique and knowledge, can alleviate the adverse physiological effects observed in preterm infants and contribute to routine nursing care in intensive care units. This study has been reported in line with STROBE checklists. No patient or public contribution was required to design or undertake this research. Patients contributed only to the data collection. This study contributes to defining the ideal endotracheal aspiration duration, as there is not enough data so far. It showed the effect of prolonged endotracheal aspiration time on cerebral oxygenation, pain and physiological parameters in preterm infants.

Evaluating the Diagnostic Performance of Nasal Methicillin-Resistant Staphylococcus aureus Polymerase Chain Reaction in Hospital-Acquired Pneumonia Within the Intensive Care Unit. A Retrospective Study.

Background: The methicillin-resistant Staphylococcus aureus (MRSA) accounts for 20% to 40% of all hospital-acquired pneumonia (HAP) cases with mortality rates up to 55%. Prompt and accurate diagnosis is essential, especially in intensive care unit (ICU) patients. Nasal MRSA polymerase chain reaction (PCR) diagnostic utility evidence is conflicting in the literature for HAP due to a low number of HAP patients included in prior studies or due to the lack of high-yield gold standard cultures defined for comparisons. Methods: This was a retrospective cohort study conducted in a 65-bed medical ICU, and encompassing all adult patients admitted from January 2015 to March 2023 for HAP. Respiratory cultures included were those obtained by bronchoalveolar lavage or endotracheal suction within 7 days of nasal MRSA PCR testing. Results: The study included 412 patients; 56.8% were males and 65% were Whites. The mean age was 60.5 years. Most patients (82.5%) underwent MRSA-PCR before intubation, and the average time between MRSA-PCR and lower respiratory cultures was 2.15 days. The diagnostic performance of nasal MRSA PCR in diagnosing HAP in the ICU yielded a sensitivity (Sen) of 47.83%, specificity (Sp) of 92.29%, positive predictive value (PPV) of 26.83%, and negative predictive value (NPV) of 96.77%. For nonventilator HAP (nv-HAP) cases sensitivity was at 50%, specificity 92.83%, PPV 28.57%, and NPV at 97.00%. In ventilator-acquired pneumonia (VAP-HAP), the corresponding values were 42.86%, 90.91%, 23.08%, and 96.15%, respectively. Conclusion: The nasal MRSA PCR shows a high NPV and low false negative rate, suggesting it is a reliable tool for ruling out MRSA HAP in ICU patients. Care should be taken into account for disease prevalence and clinical context, as these factors may influence test performance. Further validation through prospective large-sample studies utilizing high-yield lower respiratory tract cultures is necessary to confirm our findings.

Effects of Natural Sound Therapy on Pain and Agitation Induced by Endotracheal Suctioning: A Real-World Study.

Music therapy has been used as a complementary intervention to provide synergistic analgesia for various procedures. To evaluate the effects of natural sound therapy on pain intensity and agitation scores in intubated adult Chinese patients who received endotracheal suctioning in a critical care unit. A prospective, real-world, randomized, double-blind, controlled study was conducted from July 2021 through February 2022 among intubated surgical intensive care unit patients in a Chinese hospital. Patients were randomly assigned to a control group receiving conventional treatment or an intervention group receiving natural sound therapy plus conventional treatment (50 patients in each group). Patients' pain intensity and agitation levels were analyzed before, during, immediately after, 5 minutes after, and 15 minutes after completion of endotracheal suctioning. Pain intensity was assessed with the Critical-Care Pain Observation Tool (CPOT); agitation was assessed with the Richmond Agitation-Sedation Scale (RASS). According to CPOT scores, patients in the intervention group had significant relief of pain intensity during, immediately after, and 5 minutes after endotracheal suctioning compared with patients in the control group (all P < .001). The RASS scores showed that agitation levels were significant lower in the intervention group than in the control group during (P = .002) and immediately after (P < .001) endotracheal suctioning. In this real-world study, natural sound therapy was part of a holistic bundle of interventions used to reduce pain and agitation in surgical intensive care unit patients during endotracheal suctioning.

Clear amniotic fluid aspiration syndrome: A novel description of an old entity.

Clear amniotic fluid aspiration syndrome (CAF-AS) is a very rare event occurring in 0.25% of our term clear amniotic fluids deliveries. The study's aims were: 1. to characterize the risk factors and outcomes associated with Clear Amniotic Fluid Aspiration Syndrome and 2. to compare the outcomes of Clear Amniotic Fluid Aspiration to Meconium Aspiration. This was an observational study over a 22-year period in a single level-3 medical center. Compared were parturient/labor characteristics and neonatal outcomes in cases with suspected Clear Amniotic Fluid Aspiration to cases suspected for Meconium Aspiration. Out of 79,620 term deliveries there were 66,705 (83.8%) clear amniotic fluids and 12,915 (16.2%) meconium stained amniotic fluid (MSAF). Of neonates born with clear amniotic fluid, 166 (0.25%) were diagnosed with Clear Amniotic Fluid Aspiration Syndrome (CAF-AS), while 202 (15.7%) of those born with MSAF, were diagnosed with aspiration syndrome (MSAF-AS). Both conditions had comparable rates of mild manifestation (67.5% vs 69.2%, p = 0.63). Persistent pulmonary hypertension (PPH) occurred 5 times less in CAF-AS than MSAF-AS (4% vs 20%, OR 0.17, P< 0.0001) Both conditions presented similar rates of surfactant without PPH (11.1% vs 13.4%, p = 0.87). There was 1 postnatal death in CAF-AS vs 10 in MSAF. CAF-AS were quantitatively quite similar in terms of need of actual active intervention of the neonatologists in the delivery room (166 vs 202, i.e. in terms of numbers of cases and not prevalence) to MSAF-AS.We identified in these cases two major specific causes: hyperkinetic explosive deliveries in multiparas and long-lasting episodes of maternal hypotension due to epidural/spinal anaesthesia during labor. Out of 140 million births per year in the world, it should be of concern that 3 million cases are neglected nowadays. Future studies should evaluate if this CAF-AS should benefit from a more active intervention such as immediate endotracheal suction at birth, this clear fluid being very easy to suction.

Adverse effects of Mechanical Insufflation-Exsufflation in Mechanically Ventilated Patients in the Adult Intensive Care Unit - A Literature Review

Introduction Mechanical ventilation via an artificial airway can impede cough, predisposing the critically ill patient to retained secretions and an increased risk of respiratory complications. Physiotherapeutic techniques aimed at mobilising secretions and optimising airway clearance are often relied upon in this cohort. Mechanical Insufflation-Exsufflation (MI-E) is a cough augmentation device that utilises positive pressure, followed by a rapid switch to negative pressure, to simulate a cough and aid sputum clearance from proximal airways. To date, MI-E has been widely researched in the neuromuscular population, with emerging use in the critically ill. However, adverse effects associated with MI-E in intubated populations remains unknown. The aim of this review was to report on the incidence of adverse events associated with MI-E in acutely invasively ventilated critically ill patients. Methods An electronic search of online databases was conducted using AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE, SPORTDiscuss and Web of Science. Additionally, the reference lists of relevant articles were hand searched for eligible studies. Studies including adult subjects (&gt;18 years) who were invasively ventilated and receiving MI-E were deemed eligible for inclusion. The outcome of interest was adverse events. Studies were excluded if they were in a paediatric population, not written in English language and were editorials or conference papers. Quality was assessed using the Critical Skills Appraisal Programme tool. Results A total 77 citations were identified, five of which met the inclusion criteria: three randomised crossover studies, one randomised parallel-group open label trial and one case series (278 participants in total). All studies applied MI-E followed by endotracheal or tracheal suction. Insufflation and exsufflation pressures ranged from +30 to +50cmH2O and -30 to -50cmH2O across studies. Only two studies pre-defined an adverse event. Common reported measures included heart rate, systolic and diastolic blood pressure, and oxygen saturations. Two studies reported the occurrence of an adverse event (oxygen saturations, blood pressure and heart rate changes) but noted that changes were transient and not clinically significant. Overall, all studies concluded that MI-E was a safe intervention in this patient cohort. Conclusion Overall, the use of MI-E in the acutely intubated patient does not result in adverse events that are clinically significant. However, limitations to the evidence base should be acknowledged and include a lack of definition and variation in outcome measures used and small sample sizes across studies. Larger clinical trials are needed, to further evaluate the safety of MI-E on clinically important parameters that are more clearly defined.

A scoping review of pain resulting from the endotracheal suctioning of paediatric intensive care patients.

This scoping review was conducted to summarise and map studies on pain resulting from endotracheal suctioning in paediatric intensive care patients. This scoping review conducted in June 2022 was performed by screening articles published in English. Scopus, PubMed, Cochrane, Web of Science, MedLine and Ovid databases were used for screening. The keywords 'endotracheal suctioning', 'pain', 'paediatric intensive care' and their synonyms were used in the search. During the review, 280 articles were accessed, and the full texts of 14 articles were evaluated for suitability. After some of the articles were excluded from the study, abstracts of nine articles were given below. It is recommended that a greater number of randomised controlled studies should be conducted, because the number of studies with a high level of evidence on the effect of endotracheal suctioning on the pain levels of patients in the paediatric intensive care unit is very few.

Measuring pain or discomfort during routine nursing care in lightly sedated mechanically ventilated intensive care patients: A prospective preliminary cohort study

BackgroundPain is routinely measured on mechanically ventilated ICU patients. However, the tools used are not designed to discriminate between pain and non-pain discomfort, a distinction with therapeutic implications. ObjectivesTo evaluate whether clinical measurement tools can discern both pain and non-pain discomfort. MethodsA prospective observational cohort study was conducted in a General ICU at a tertiary Medical Center in Israel. The Behavior Pain Scale (BPS) and Visual Analog Scale (VAS) of Discomfort were simultaneously assessed by a researcher and bedside nurse on thirteen lightly sedated patients during 71 routine nursing interventions in lightly sedated, mechanically ventilated, adult patients. Patients were asked whether they were in pain due to these interventions. ResultsStatistically significant increases from baseline during interventions were observed [median change: 1.00 (-1–5), 1.5(-4–8.5), p < 0.001] as measured by BPS and VAS Discomfort Scale, respectively. BPS scores ranged between 4 and 6 when the majority (53 %) of the patients replied that they had no pain but were interpreted by the clinicians as discomfort. Endotracheal suctioning caused the greatest increase in BPS and VAS, with no statistically significant differences in BPS and VAS Discomfort Scale scores whether patients reported or did not report pain. A BPS>6 had a higher sensitivity and specificity to reported pain (accuracy of 76 %) compared to a BPS of 4–6. ConclusionsStandard assessments are sensitive to pain caused by routine nursing care interventions. However, this study presents evidence that among lightly sedated ICU patients, moderate BPS scores could also measure non-pain discomfort. ICU nurses should be aware that signs of unpleasantness measured by a pain scale could reflect non-pain discomfort.

Clinical Efficacy and Safety of an Automatic Closed-Suction System in Mechanically Ventilated Patients with Pneumonia: A Multicenter, Prospective, Randomized, Non-Inferiority, Investigator-Initiated Trial.

Endotracheal suctioning is an essential but labor-intensive procedure, with the risk of serious complications. A brand new automatic closed-suction device was developed to alleviate the workload of healthcare providers and minimize those complications. We evaluated the clinical efficacy and safety of the automatic suction system in mechanically ventilated patients with pneumonia. In this multicenter, randomized, non-inferiority, investigator-initiated trial, mechanically ventilated patients with pneumonia were randomized to the automatic device (intervention) or conventional manual suctioning (control). The primary efficacy outcome was the change in the modified clinical pulmonary infection score (CPIS) in 3 days. Secondary outcomes were the frequency of additional suctioning and the amount of secretion. Safety outcomes included adverse events or complications. A total of 54 participants, less than the pre-determined number of 102, were enrolled. There was no significant difference in the change in the CPIS over 72 h (-0.13 ± 1.58 in the intervention group, -0.58 ± 1.18 in the control group, p = 0.866), but the non-inferiority margin was not satisfied. There were no significant differences in the secondary outcomes and safety outcomes, with a tendency for more patients with improved tracheal mucosal injury in the intervention group. The novel automatic closed-suction system showed comparable efficacy and safety compared with conventional manual suctioning in mechanically ventilated patients with pneumonia.

Efficiency of the Educational Material in Enhancing Nurses' Understanding of Endotracheal Suctioning at Iraq/Kirkuk City

Efficiency of the Educational Material in Enhancing Nurses' Understanding of Endotracheal Suctioning at Iraq/Kirkuk City

Development and Safety Trial of the OstreaVent2™ Prototype for Mechanically Ventilated Adult Patients.

With the surge of COVID-19 infections, there were concerns about shortage of mechanical ventilator in several countries including the Philippines. To transform a locally made, low-cost, neonatal ventilator into a volume- and pressure-controlled, adult ventilator and to determine its safe use among ventilated, adult patients at the Philippine General Hospital. The modification of the neonatal ventilator (OstreaVent1) to the adult OstreaVent2 was based on the critical need for adult ventilators, in volume or pressure mode, in the Philippines due to the COVID-19 pandemic. The adult ventilator settings were calibrated and tested for two days to check for consistency and tolerance and then submitted to a third party for certification. Once certified, a safety trial of 10 stable adult patients on mechanical ventilator was conducted. The patients were placed on the OstreaVent2 for four hours while ventilator parameters, patient's vital signs, and arterial blood gases were monitored at baseline, during, and after placement on the OstreaVent2. A post-study chest radiograph was also done to rule out pulmonary complications, particularly atelectasis and pneumothorax. The prototype OstreaVent2 received an FDA Certification for Medical Listing after passing its third-party certification. Ten patients (60% male) recruited in the study had a mean age of 39.1 ± 11.6 years. Half of the patients had a diagnosis of non-COVID-19 pneumonia. During the 4-hour study period, the patients while on the OstreaVent2, had stable ventilator settings and most of the variabilities were within the acceptable tolerances. Vital signs were stable and arterial blood gases were within normal limits. One patient developed alar flaring which was relieved by endotracheal tube suctioning. No patient was withdrawn from the study. One patient who was already transferred out of the ICU subsequently deteriorated and died three days after transfer to the stepdown unit from a non-ventilator related cause. The new OstreaVent2 is safe to use among adults who need ventilator support. Variabilities in the ventilator's performance were within acceptable tolerances. Clinical and blood gas measurements of the patients were stable while on the ventilator.

Suctioning in intubated and tracheotomized patients : Anarrative review

Endotracheal suctioning in intubated or tracheotomized critically ill patients is adaily task of various professional groups in intensive and emergency medicine; however, aGerman language summary of current evidence is lacking. The aim is to develop anarrative overview of current evidence on endotracheal suctioning of intubated or tracheotomized patients in the clinical setting. Aliterature search was conducted in the databases Cinahl, Cochrane Library, Livivo, and Medline via PubMed by nurses with an academic degree. In addition, ahand search and applying the snowball principle were performed. Following asuccessful critical appraisal, all English and German language publications addressing endotracheal suctioning in the context of hospital care were included. Atotal of 23 full texts were included. After developing 6 main topics on endotracheal suction 19articles were considered in the reporting. The results showed, among others, that routine deep suctioning once per shift is contraindicated and that the catheter should be advanced no more than 0.5-1 cm beyond the distal end of the tube or tracheal cannula. Closed suction catheters offer advantages, especially for staff protection, although studies are heterogeneous. Further training of staff is obligatory. Few conclusive studies on endotracheal suction could be found; however, with the available evidence initial conclusions can be drawn which should be considered in, for example, internal standard operating procedures. Further research is needed.

The Effect of Breast Milk Odor on the Pain and Stress Levels of the Newborn During the Endotracheal Suction Procedure.

Objective: The study aimed to determine the effect of the breast milk odor on the pain and stress levels of the newborn during the endotracheal suction procedure. Method: The study was conducted in the randomized-controlled experimental design at the neonatal intensive care unit of the hospital in eastern Turkey between March 2022 and December 2023. The study population included newborns at the 37th to 41st gestational weeks who were receiving mechanical ventilation treatment in the neonatal intensive care unit of a hospital in eastern Turkey. All newborns who met the inclusion criteria during the data collection phase were included in the study. The study was completed with 88 newborns (44 in the intervention group and 44 in the control group). The Newborn Introductory Information Form, ALPS-Neo Newborn Pain and Stress Assessment Scale, and follow-up form were used to collect the study data. The breast milk odor of the mothers of the newborns was used as the intervention group in the study. The mothers of the newborns were contacted to obtain breast milk, and the information was obtained from the mother on the day of the procedure. One milliliter of breast milk was taken and dropped into a sterile sponge, and it was held 10 cm away from the baby's nose from 5 minutes before to 5 minutes after endotracheal suction. A routine endotracheal suction process was performed in the control group. Ethical principles were followed in the study. Results: We found that the intervention group's pain and stress score averages were lower than the control group during and after the endotracheal suction procedure (p < 0.05). Conclusion: We found that the breast milk odor reduced the pain, stress levels, and crying duration of newborns during the endotracheal suction process.

Meconium aspiration syndrome: from pathophysiology to treatment.

Meconium aspiration syndrome (MAS) is a clinical condition characterized by respiratory distress in neonates born through meconium-stained amniotic fluid (MSAF). Despite advances in obstetric practices and perinatal care, MAS remains an important cause of morbidity and mortality in term and post-term newborns. Since the 1960s, there have been significant changes in the perinatal and postnatal management of infants born through MSAF. Routine endotracheal suctioning is no longer recommended in both vigorous and non-vigorous neonates with MSAF. Supportive care along with new treatments such as surfactant, inhaled nitric oxide, and high-frequency ventilation has significantly improved the outcome of MAS patients. However, determining the most appropriate approach for this condition continues to be a topic of debate. This review offers an updated overview of the epidemiology, etiopathogenesis, diagnosis, management, and prognosis of infants with MAS.

Design and content validation of a checklist about infection-prevention performance of intensive care nurses in simulation-based scenarios.

To design, develop and validate a new tool, called NEUMOBACT, to evaluate critical care nurses' knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention through simulation scenarios involving central venous catheter (CVC), endotracheal suctioning (ETS) and mechanically ventilated patient care (PC) stations. Simulation-based training is an excellent way for nurses to learn prevention measures in VAP and CRB. Descriptive metric study to develop NEUMOBACT and analyse its content and face validity that followed the COSMIN Study Design checklist for patient-reported outcome measurement instruments. The first version was developed with the content of training modules in use at the time (NEUMOBACT-1). Delphi rounds were used to assess item relevance with experts in VAP and CRB prevention measures, resulting in NEUMOBACT-2. Experts in simulation methods then assessed feasibility, resulting in NEUMOBACT-3. Finally, a pilot test was conducted among 30 intensive care unit (ICU) nurses to assess the applicability of the evaluation tool in clinical practice. Seven national experts in VAP and CRB prevention and seven national simulation experts participated in the analysis to assess the relevance and feasibility of each item, respectively. After two Delphi rounds with infection experts, four Delphi rounds with simulation experts, and pilot testing with 30 ICU nurses, the NEUMOBACT-FINAL tool consisted of 17, 26 and 21 items, respectively, for CVC, ETS and PC. NEUMOBACT-FINAL is useful and valid for assessing ICU nurses' knowledge and skills in VAP and CRB prevention, acquired through simulation. Our validated and clinically tested tool could facilitate the transfer of ICU nurses' knowledge and skills learning in VAP and CRB prevention to critically ill patients, decreasing infection rates and, therefore, improving patient safety. Experts participated in the Delphi rounds and nurses in the pilot test.

Non-pharmacological interventions for the prevention of pain during endotracheal suctioning in ventilated neonates.

Pain, when treated inadequately, puts preterm infants at a greater risk of developing clinical and behavioural sequelae because of their immature pain system. Preterm infants in need of intensive care are repeatedly and persistently exposed to noxious stimuli, and this happens during a critical window of their brain development with peak rates of brain growth, exuberant synaptogenesis and the developmental regulation of specific receptor populations. Nearly two-thirds of infants born at less than 29 weeks' gestation require mechanical ventilation for some duration during the newborn period. These neonates are endotracheally intubated and require repeated endotracheal suctioning. Endotracheal suctioning is identified as one of the most frequent and most painful procedures in premature infants, causing moderate to severe pain. Even with improved nursing performance and standard procedures based on neonatal needs, endotracheal suctioning remains associated with mild pain. To evaluate the benefits and harms of non-pharmacological interventions for the prevention of pain during endotracheal suctioning in mechanically ventilated neonates. Non-pharmacological interventions were compared to no intervention, standard care or another non-pharmacological intervention. We conducted searches in June 2023 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, Embase, CINAHL and three trial registries. We searched the reference lists of related systematic reviews, and of studies selected for inclusion. We included randomised controlled trials (RCTs), quasi-RCTs and cluster-RCTs that included term and preterm neonates who were mechanically ventilated via endotracheal tube or via tracheostomy tube and required endotracheal suctioning performed by doctors, nurses, physiotherapists or other healthcare professionals. Our main outcome measures were validated composite pain scores (including a combination of behavioural, physiological and contextual indicators). Secondary outcomes included separate physiological and behavioural pain indicators. We used standard methodological procedures expected by Cochrane. For continuous outcome measures, we used a fixed-effect model and reported mean differences (MDs) with 95% confidence intervals (CIs). For categorical outcomes, we reported the typical risk ratio (RR) and risk difference (RD) and 95% CIs. We assessed risk of bias using the Cochrane RoB 1 tool, and assessed the certainty of the evidence using GRADE. We included eight RCTs (nine reports), which enroled 386 infants, in our review. Five of the eight studies were included in a meta-analysis. All studies enrolled preterm neonates. Facilitated tucking versus standard care (four studies) Facilitated tucking probably reduces Premature Infant Pain Profile (PIPP) score during endotracheal suctioning (MD -2.76, 95% CI 3.57 to 1.96; I² = 82%; 4 studies, 148 infants; moderate-certainty evidence). Facilitated tucking probably has little or no effect during endotracheal suctioning on: heart rate (MD -3.06 beats per minute (bpm), 95% CI -9.33 to 3.21; I² = 0%; 2 studies, 80 infants; low-certainty evidence); oxygen saturation (MD 0.87, 95% CI -1.33 to 3.08; I² = 0%; 2 studies, 80 infants; low-certainty evidence); or stress and defensive behaviours (SDB) (MD -1.20, 95% CI -3.47 to 1.07; 1 study, 20 infants; low-certainty evidence). Facilitated tucking may result in a slight increase in self-regulatory behaviours (SRB) during endotracheal suctioning (MD 0.90, 95% CI 0.20 to 1.60; 1 study, 20 infants; low-certainty evidence). No studies reported intraventricular haemorrhage (IVH). Familiar odour versus standard care (one study) Familiar odour during endotracheal suctioning probably has little or no effect on: PIPP score (MD -0.30, 95% CI -2.15 to 1.55; 1 study, 40 infants; low-certainty evidence); heart rate (MD -6.30 bpm, 95% CI -16.04 to 3.44; 1 study, 40 infants; low-certainty evidence); or oxygen saturation during endotracheal suctioning (MD -0.80, 95% CI -4.82 to 3.22; 1 study, 40 infants; low-certainty evidence). No studies reported SRB, SDB or IVH. White noise (one study) White noise during endotracheal suctioning probably has little or no effect on PIPP (MD -0.65, 95% CI -2.51 to 1.21; 1 study, 40 infants; low-certainty evidence); heart rate (MD -1.85 bpm, 95% CI -11.46 to 7.76; 1 study, 40 infants; low-certainty evidence); or oxygen saturation (MD 2.25, 95% CI -2.03 to 6.53; 1 study, 40 infants; low-certainty evidence). No studies reported SRB, SDB or IVH. Facilitated tucking / four-handed care / gentle human touch probably reduces PIPP score. The evidence of a single study suggests that facilitated tucking / four-handed care / gentle human touch slightly increases self-regulatory and approach behaviours during endotracheal suctioning. Based on a single study, familiar odour and white noise have little or no effect on any of the outcomes compared to no intervention. The use of expressed breast milk or oral sucrose suggests that there is no discernible advantage of one method over the other for reducing pain during endotracheal suctioning. None of the studies reported on any of the prespecified secondary outcomes of adverse events.