dc.contributor.author | Schults, Jessica A | |
dc.contributor.author | Cooke, Marie | |
dc.contributor.author | Long, Debbie | |
dc.contributor.author | Schibler, Andreas | |
dc.contributor.author | Ware, Robert S | |
dc.contributor.author | Charles, Karina | |
dc.contributor.author | Irwin, Adam | |
dc.contributor.author | Mitchell, Marion L | |
dc.date.accessioned | 2021-06-03T03:24:43Z | |
dc.date.available | 2021-06-03T03:24:43Z | |
dc.date.issued | 2021 | |
dc.identifier.issn | 1036-7314 | |
dc.identifier.doi | 10.1016/j.aucc.2021.01.006 | |
dc.identifier.uri | http://hdl.handle.net/10072/404898 | |
dc.description.abstract | Background/objective
Endotracheal suction is one of the most common and harmful procuedres performed on mechanically ventilated children. The aim of the study was to establish the feasibility of a randomised controlled trial (RCT) examining the effectiveness of normal saline instillation (NSI) and a positive end-expiratory pressure recruitment manoeuvre (RM) with endotracheal suction in the paediatric intensive care unit.
Methods
Pilot 2 × 2 factorial RCT.
The study was conducted at a 36-bed tertiary paediatric intensive care unit in Australia.
Fifty-eight children aged less than 16 years undergoing tracheal intubation and invasive mechanical ventilation.
(i) NSI or no NSI and (ii) RM or no RM with endotracheal suction . The primary outcome was feasibility; secondary outcomes were ventilator-associated pneumonia (VAP), change in end-expiratory lung volume assessed by electrical impedance tomography, dynamic compliance, and oxygen saturation-to-fraction of inspired oxygen (SpO2/FiO2) ratio.
Results/Findings
Recruitment, retention, and missing data feasibility criteria were achieved. Eligibility and protocol adherence criteria were not achieved, with 818 patients eligible and 58 enrolled; cardiac surgery was the primary reason for exclusion. Approximately 30% of patients had at least one episode of nonadherence. Children who received NSI had a reduced incidence of VAP; however, this did not reach statistical significance (incidence rate ratio = 0.12, 95% confidence interval = 0.01–1.10; p = 0.06). NSI was associated with a significantly reduced SpO2/FiO2 ratio up to 10 min after suction. RMs were not associated with a reduced VAP incidence (incidence rate ratio = 0.31, 95% confidence interval = 0.05–1.88), but did significantly improve end-expiratory lung volume at 2 and 5 min after suction, dynamic compliance, and SpO2/FiO2 ratio.
Conclusion
RMs provided short-term improvements in end-expiratory lung volume and oxygenation. NSI with suction led to a reduced incidence of VAP; however, a definitive RCT is needed to test statistical differences. A RCT of study interventions is worthwhile and may be feasible with protocol modifications including the widening of participant eligibility. | |
dc.description.peerreviewed | Yes | |
dc.language | en | |
dc.publisher | Elsevier BV | |
dc.relation.ispartofjournal | Australian Critical Care | |
dc.subject.fieldofresearch | Clinical sciences | |
dc.subject.fieldofresearch | Nursing | |
dc.subject.fieldofresearchcode | 3202 | |
dc.subject.fieldofresearchcode | 4205 | |
dc.title | Normal saline and lung recruitment with paediatric endotracheal suction (NARES): A pilot, factorial, randomised controlled trial | |
dc.type | Journal article | |
dc.type.description | C1 - Articles | |
dcterms.bibliographicCitation | Schults, JA; Cooke, M; Long, D; Schibler, A; Ware, RS; Charles, K; Irwin, A; Mitchell, ML, Normal saline and lung recruitment with paediatric endotracheal suction (NARES): A pilot, factorial, randomised controlled trial, Australian Critical Care, 2021 | |
dc.date.updated | 2021-06-03T03:23:16Z | |
gro.description.notepublic | This publication has been entered in Griffith Research Online as an advanced online version. | |
gro.hasfulltext | No Full Text | |
gro.griffith.author | Ware, Robert | |
gro.griffith.author | Schults, Jessica | |
gro.griffith.author | Mitchell, Marion L. | |
gro.griffith.author | Cooke, Marie L. | |