Biomaterial Database

Normal Saline and Lung Recruitment With Paediatric Endotracheal Suction: A Review and Critical Appraisal of Practice Recommendations. 2020

Jessica A Schults, and Marie Cooke, and Debbie A Long, and Marion L Mitchell

Jessica A. Schults, PhD, RN, is research fellow, Department of Anaesthesia and Pain Management, Queensland Children's Hospital; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University; and Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia. Marie Cooke, PhD, RN, is professor of nursing, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia. Debbie A. Long, PhD, RN, is associate professor and paediatric intensive care nurse researcher, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University; Paediatric Intensive Care Unit, Queensland Children's Hospital; and Paediatric Critical Care Research Group, The University of Queensland, Australia. Marion L. Mitchell, PhD, RN, is professor of critical care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University; and Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia.

BACKGROUND Normal saline instillation (NSI) and lung recruitment manoeuvres (RMs) are used in conjunction with endotracheal suction (ETS) in mechanically ventilated children. Practice is varied, and it is not currently understood what clinical practice guidelines (CPGs) are available to inform practice decisions. OBJECTIVE The aim of this study was to identify and systematically review the quality of existing ETS CPGs, specifically in the context of NSI and RM use. METHODS A systematic search for ETS CPGs in children (<18 years old) was conducted in Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, EMBASE, and Google Scholar. Two independent assessors evaluated CPGs using the Appraisal of Guidelines for Research and Evaluation II instrument. Standardised scores were calculated for individual CPGs, and scale domain scores were calculated. RESULTS Four CPGs and practice recommendations from 2 literature reviews were identified and evaluated. The routine use of NSI and RMs with paediatric ETS was not recommended. Recommendations reflected the low quality and limited availability of evidence to inform NSI and RM application. Collectively, the highest scoring domain was clarity of presentation, followed by scope and purpose (78). Overall assessments ranged from 8 to 100 from a possible 100 points. Four ETS CPGs (100%) were recommended for use with modification. CONCLUSIONS Clinical practice guidelines and practice recommendations pertaining to NSI and RM were consistent but, however, limited by the quality and volume of available evidence. Clinical practice guideline developers should focus on improving the applicability and rigour in development processes. Further consensus work and rigorous trials are needed to inform future CPGs.

UI	MeSH Term	Description	Entries
D008168	Lung	Either of the pair of organs occupying the cavity of the thorax that effect the aeration of the blood.	Lungs
D002648	Child	A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL.	Children
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000077330	Saline Solution	A crystalloid solution that contains 9.0g of SODIUM CHLORIDE per liter of water. It has a variety of uses, including: as a CONTACT LENS SOLUTION, in OPHTHALMIC SOLUTIONS and NASAL LAVAGE, in wound irrigation, and for FLUID THERAPY.	0.9% NaCl,0.9% Saline,Normal Saline,Saline, 0.9%,Saline, Normal
D000293	Adolescent	A person 13 to 18 years of age.	Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D013396	Suction	The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure.	Aspiration, Mechanical,Drainage, Suction,Aspirations, Mechanical,Drainages, Suction,Mechanical Aspiration,Mechanical Aspirations,Suction Drainage,Suction Drainages,Suctions