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dc.contributor.authorSchults, Jessica A
dc.contributor.authorCooke, Marie
dc.contributor.authorLong, Debbie
dc.contributor.authorSchibler, Andreas
dc.contributor.authorWare, Robert S
dc.contributor.authorCharles, Karina
dc.contributor.authorIrwin, Adam
dc.contributor.authorMitchell, Marion L
dc.date.accessioned2021-06-03T03:24:43Z
dc.date.available2021-06-03T03:24:43Z
dc.date.issued2021
dc.identifier.issn1036-7314
dc.identifier.doi10.1016/j.aucc.2021.01.006
dc.identifier.urihttp://hdl.handle.net/10072/404898
dc.description.abstractBackground/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.peerreviewedYes
dc.languageen
dc.publisherElsevier BV
dc.relation.ispartofjournalAustralian Critical Care
dc.subject.fieldofresearchClinical sciences
dc.subject.fieldofresearchNursing
dc.subject.fieldofresearchcode3202
dc.subject.fieldofresearchcode4205
dc.titleNormal saline and lung recruitment with paediatric endotracheal suction (NARES): A pilot, factorial, randomised controlled trial
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationSchults, 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.updated2021-06-03T03:23:16Z
gro.description.notepublicThis publication has been entered in Griffith Research Online as an advanced online version.
gro.hasfulltextNo Full Text
gro.griffith.authorWare, Robert
gro.griffith.authorSchults, Jessica
gro.griffith.authorMitchell, Marion L.
gro.griffith.authorCooke, Marie L.


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