Long-Term Effects of Saline Instilled During Endotracheal Suction in Pediatric Intensive Care: A Randomized Trial

Abstract

Background Saline instillation is still used to assist in removal of secretions from endotracheal tubes in some pediatric intensive care units. Objective To compare the effect of using either no saline, quarter-normal (0.225%) saline, or normal (0.9%) saline during endotracheal suctioning of children receiving ventilatory support in a pediatric intensive care unit. Method An unblinded, randomized trial with 3 treatment groups was conducted with 427 children who received ventilatory support for at least 12 hours. Children were randomly assigned to receive no saline, 0.225% saline, or 0.9% saline during routine endotracheal suctioning. Results The primary outcome was the number of hours of invasive mechanical ventilation; oxygen therapy and length of stay in the unit were secondary outcomes. There were 138 children randomly assigned to the no-saline group, 141 to the 0.225% saline group, and 148 to the 0.9% saline group. In Kaplan-Meier intention-to-treat analysis, the median (interquartile range) number of hours of invasive mechanical ventilation was 32 (20–68), 43 (21–86), and 40 (20–87) in the no-saline, 0.225% saline, and 0.9% saline groups, respectively. Although the no-saline group received fewer hours of invasive ventilation, oxygen therapy, and intensive care than the other groups combined, the differences were not statistically significant. Conclusion Using no saline was at least as effective as using either 0.225% or 0.9% saline in endotracheal suctioning. The optimal policy may be to routinely use no saline with endotracheal suctioning in children but allow the occasional use of 0.9% saline when secretions are thick.

AARC Clinical Practice Guidelines: Artificial Airway Suctioning

“…66 Normal saline solution use during artificial airway suctioning has also been shown to increase dyspnea in patients $ 60 years of age. 73 McKinley et al 74 performed a randomized trial to evaluate the hours of intubation and invasive mechanical ventilation in pediatric subjects. They found that using no saline solution was as effective as using quarter-normal or normal saline solution.…”

“…They found that using no saline solution was as effective as using quarter-normal or normal saline solution. 74 In a prospective observational study, Owen et al 71 noted more adverse events in pediatric subjects who received normal saline solution during suctioning events. A randomized clinical trial by Caruso et al 75 noted a decrease in microbiologically proven VAP with the use of normal saline solution during artificial airway suctioning.…”

Pulmonary Specific Ancillary Treatment for Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

“…Isotonic saline has been used to clear secretions from the endotracheal tube; however, there are considerations for harm. In intubated children, not specifically with PARDS, McKinley et al (49) randomized 427 to one of three endotracheal suctioning treatment groups: no saline, 0.2% saline, and 0.9% saline instillation. No saline use was just as effective as either saline instillation.…”

Rational use of mucoactive medications to treat pediatric airway disease

“…Disappointingly, few randomized controlled studies have so far studied the effectiveness of mucoactive agents during invasive mechanical ventilation in an either specific or general PICU population. McKinley et al have investigated the effect of no saline versus 0.225% or 0.9% saline installation before routine endotracheal suction to remove phlegm in 427 children receiving ventilator support [102]. However, in this non-blinded trial, no statistically significant differences in duration of mechanical ventilation, oxygen therapy or PICU stay between the groups were found.…”