The effect of different suctioning modalities on physiologic measures and the incidence of ventilator associated pneumonia

Hussein, Khaled Ibrahim; Zahran, Eman; Badr, Lina Kurdahi; Kanafani, Zeina A.

doi:10.5430/jnep.v7n1p1

Cited by 3 publications

(4 citation statements)

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“…Hussein et al investigated the effect of normal saline serum on VAP and physiological parameters. The findings showed that normal saline effectively increased the incidence of pneumonia (12). Several studies have reported adverse effects of normal saline on physiological parameters and the likelihood of pneumonia in patients undergoing mechanical ventilation (1,12,22,23).…”

Section: Discussionmentioning

confidence: 91%

“…In their systematic study by Pinto et al, nurses believed that normal saline diluted the secretions, facilitated the insertion of the catheter into the tracheal tube, stimulated the cough reflex and discharge of secretions, and increased oxygenation (11). The findings of a study showed that the pneumonia rate was significantly higher in patients using normal saline to suction secretions (12). Some studies have indicated that using normal saline during tracheal suction causes hypoxia, high blood pressure, bronchospasm, and the displacement of bacterial colonies and their movement to the lower airways, thereby aggravating hospital-acquired pneumonia (13).…”

Section: Introductionmentioning

confidence: 99%

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The Effects of Tracheal Suction with N-acetylcysteine on Incidence of Ventilator-associated Pneumonia

et al. 2023

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Background: Correct endotracheal tube suction is one of the effective methods to prevent ventilator-associated infection. Many studies have reported that normal saline and N-acetylcysteine (NAC) in the trachea lead the translocation of bacteria to lower levels and increase the risk of pneumonia. Objectives: The present study sought to examine the effect of tracheal suction with NAC on the incidence of ventilator-associated pneumonia (VAP). Methods: This single-blind randomized clinical trial study was conducted on 60 patients admitted to the intensive care unit (ICU) of the Khatam Al-Anbia Hospital in Zahedan, Iran, in 2020. The patients were selected using the convenience sampling method and assigned into two intervention and control groups by permutation block randomization. Before the intervention, the patients were evaluated using the Modified Clinical Pulmonary Infection Score (MCPIS), and the patients with scores < 5 on this scale were included in the study. Suctioning tracheal secretions in the intervention group was performed by pouring 2 cc of NAC into the tracheal tube during suction. The same suction procedure was performed for the patients in the control group by pouring 2 cc of normal saline into the tracheal tube in a standard way. The intervention was conducted for five days. After the intervention, the MCPIS scale was administered once more for the two groups. The collected data were analyzed using the independent samples t-test and chi-square test with SPSS software (version 25). Results: The independent samples t-test showed no significant difference between the intervention and control groups regarding the incidence of pneumonia (P = 0.31). Conclusions: Despite the effect of NAC on the incidence rate of pneumonia in patients under mechanical ventilation, there was no significant difference between NAC and normal saline in reducing the incidence of pneumonia. However, since NAC leads to no specific complication in patients, it can be safely used in the suction of tracheal lobule secretions in patients under ventilators. In this regard, further studies should examine the use of NAC for suctioning during tracheal tube obstruction by secretions.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The Effects of Tracheal Suction with N-acetylcysteine on Incidence of Ventilator-associated Pneumonia

et al. 2023

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“…Evidence suggests that although normal saline is frequently used in endotracheal intubation, different studies have reported different results on whether or not to use it (8,9). For example, Hussein et al (10) conducted a study entitled "The effect of different suctioning modalities on physiologic measures and the incidence of ventilator-associated pneumonia". In this study, the results showed that the use of normal saline before suction does not cause significant changes in hemodynamic parameters but increases the amount of VAP.…”

Section: Introductionmentioning

confidence: 99%

The effect of different solutions in tracheal suctioning on the incidence of pneumonia in patients on the ventilator

Chai¹,

Liu²,

Zhao³

2022

Cell Mol Biol (Noisy-le-grand)

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Ventilator-associated pneumonia (VAP) is a common nosocomial infection in patients admitted to intensive care units (ICU), leading to prolonged stay in the ICU, increased hospital costs, and mortality. This study aimed to compare the effect of using normal saline with eucalyptus in endotracheal suctioning on the rate of ventilator-dependent pneumonia. For this purpose, a randomized clinical trial study was performed on 120 patients under a ventilator in the hospital ICU. Patients were randomly divided into control and intervention groups. The control group consisted of 60 patients who used 0.9% normal saline to dilute endotracheal secretions. The intervention group also included 60 patients treated with 0.9% normal saline with 5% eucalyptus to dilute endotracheal secretions. The sensitivity of isolated microbes was determined by the diffusion susceptibility test Kirby-Bauer disk protocol. The CDC protocol was used to diagnose VAP. 100 CFU/ml of endotracheal aspiration was considered the differentiation number between the microbe responsible for VAP and colonization. Whenever a VAP guess was made, a blood culture was done. Finally, the incidence of ventilator-associated pneumonia in the two groups was compared. The results showed that the incidence of VAP during using normal saline and normal saline with eucalyptus as a diluent for pulmonary secretions was different between the two groups (P = 0.042). Also, among infected patients with VAP, there was a difference between the types of microorganisms in the two groups (P = 0.019). Seven cases of Klebsiella pneumonia were observed in the control group, while no case of this bacterium was observed in the intervention group. In terms of the prevalence of Pseudomonas (two cases), both groups had a similar situation. These findings can reassure nurses and the treatment team that they can use normal saline solution with 5% eucalyptus during suction to dilute pulmonary secretions.

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“…Although few studies evaluated the instillation of NS in adults, to the authors' knowledge and the literature review (Hussein et al, 2017;Alja'afreh et al, 2018), this is the first study that aims to examine the practice of instilling NS prior to endotracheal suctioning in NICUs in Jordan. To date, no studies have explored the nature and extent of this practice.…”

Section: Introductionmentioning

confidence: 99%

Normal Saline Instillation at Neonatal Intensive Care Units: A Descriptive Study of Neonatal Nurses' Knowledge and Practice

Kassab¹,

Rababaah²,

Khriesat³

et al. 2022

JJNR

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Background: Current evidence no longer supports the instillation of normal saline (NS) during endotracheal suctioning. However, it is unclear whether and to what extent nurses practice NS instillation in Jordan’s neonatal intensive-care units (NICUs). Purpose: To describe the knowledge and practice of Jordanian nurses regarding NS instillation before endotracheal suctioning. Methods: A cross-sectional descriptive method was used. Data was collected from 136 NICU nurses using a 29-item self-administered questionnaire. The participants were from 7 NICUs of 7 hospitals in Jordan (north, middle and south of Jordan). The questionnaire asked participants about their knowledge and practice regarding endotracheal suctioning. Results: Findings showed a high frequency of NS instillation during endotracheal suctioning. Among the participants, 44.1% believed that NS was beneficial in loosening secretions, 57.4% believed that it could stimulate the cough response, 56.6% believed that it promoted neonate comfort and 41.2% believed that it could reduce bacterial growth. In practice, 80.0% of nurses used open rather than closed suctioning, 57.1% did not use more than 5 ml of NS during suctioning and 92.4%. instilled 0.9% normal saline directly onto the endotracheal tube rather than the in-line suction adapter. Moreover, 53.7% of participants reported that suctioning mechanically ventilated premature neonates out of regularity and not because it was clinically indicated. Conclusion: This is the first study that explored NICU nurses’ knowledge and practice of NS use during endotracheal suctioning in Jordan. Educational programs can be implemented to improve knowledge regarding the complications of NS instillation. Implications for Nursing: NICU guidelines should be implemented to ensure that suctioning practices reflect current standards and education and training programs should be developed to target the knowledge and skills of nurses Keywords: Normal saline instillation, Suctioning, Endotracheal tube, NICUs, Jordan.

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The effect of different suctioning modalities on physiologic measures and the incidence of ventilator associated pneumonia

Cited by 3 publications

References 32 publications

The Effects of Tracheal Suction with N-acetylcysteine on Incidence of Ventilator-associated Pneumonia

The Effects of Tracheal Suction with N-acetylcysteine on Incidence of Ventilator-associated Pneumonia

The effect of different solutions in tracheal suctioning on the incidence of pneumonia in patients on the ventilator

Normal Saline Instillation at Neonatal Intensive Care Units: A Descriptive Study of Neonatal Nurses' Knowledge and Practice

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