Appropriate use criteria for endotracheal suction interventions in mechanically ventilated children: The RAND/UCLA development process

Abstract

Objectives: Endotracheal suction is an invasive airway clearance technique used in mechanically ventilated children. This article outlines the methods used to develop appropriate use criteria for endotracheal suction interventions in mechanically ventilated paediatric patients. Methods: The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop paediatric appropriate use criteria. This included the following sequential phases of defining scope and key terms, a literature review and synthesis, expert multidisciplinary panel selection, case scenario development, and appropriateness ratings by an interdisciplinary expert panel over two rounds. The panel comprised experts in the fields of paediatric and neonatal intensive care, respiratory medicine, infectious diseases, critical care nursing, implementation science, retrieval medicine, and education. Case scenarios were developed iteratively by interdisciplinary experts and derived from common applications or anticipated intervention uses, as well as from current clinical practice guidelines and results of studies examining interventions efficacy and safety. Scenarios were rated on a scale of 1 (harm outweighs benefit) to 9 (benefit outweighs harm), to define appropriate use (median: 7 to 9), uncertain use (median: 4 to 6), and inappropriate use (median: 1 to 3) of endotracheal suction interventions. Scenarios were than classified as a level of appropriateness. Conclusions: The RAND Corporation/University of California, Los Angeles Appropriateness Method provides a thorough and transparent method to inform development of the first appropriate use criteria for endotracheal suction interventions in paediatric patients.

The Performance Level of Critical Care Nurses Toward Two Systems of Endotracheal Suction among Mechanically Ventilated Patients

“…There are two systems at play: the open suction system (OSS), which is still the standard suction technique and necessitates using a single-use catheters and removing the ventilator from the patient. [6] Nevertheless, it is claimed that when using ETS procedures, a closed suction system (CSS) can stay in line with a multiple-use catheter for a full day through the plastic sheath of the multi-use drain [7].…”

Effect of routine suction on lung aeration in critically ill neonates and young infants measured with electrical impedance tomography

“…We concentrate not on immediate suctioning effects which have been addressed previously but on possible later changes between five and ten minutes after the intervention. The information on the effects of suctioning might contribute to better assessment of its efficacy and improve the indications of this intervention, known to be associated with complications in a large proportion of patients 9 .…”

Cardiothoracic Care Nurses' Practice and Beliefs toward Endotracheal Suction Post Coronary Artery Bypass Graft at Teaching Hospital

“…This could be due to resistance to change or a lack of resources. Nurses' beliefs can be broadly described as a subjective attitude that a proposition is true or as a situation that can influence nurses' ability to provide care for patients [11,12]. Recently, Endotracheal suction has been assumed new guidelines' technique to be a new challenge in plus traditional technique.…”