Normal saline and lung recruitment with paediatric endotracheal suction (NARES): A pilot, factorial, randomised controlled trial

Schults, Jessica; Cooke, Marie; Long, Debbie; Schibler, Andreas; Ware, Robert S.; Charles, Karina; Irwin, Adam; Mitchell, Marion

doi:10.1016/j.aucc.2021.01.006

Cited by 5 publications

(1 citation statement)

References 49 publications

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“…(26) Aunque los resultados indicaron que algunos de los métodos evaluados podrían tener un impacto en la prevención de la neumonía asociada a ventilador, se señala la necesidad de más investigaciones para determinar diferencias estadísticamente significativas. (27) Encontramos que algunos estudios se centraron en intervenciones específicas para prevenir la neumonía asociada al ventilador, como la elevación de la cabeza de la cama y el uso de clorhexidina. Todos demostraron reducciones en la incidencia de NAV o infecciones respiratorias.…”

Section: Resultados Y Discusiónunclassified

Nursing care to prevent ventilator-associated pneumonias in adult patients

Delgado Mejía

2023

Community and Interculturality in Dialogue

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INTRODUCTION: Pneumonia associated with mechanical ventilation is a serious complication in patients with artificial airway in intensive care units, increasing morbidity and mortality. It increases the use of antibiotics, oropharyngeal microbial resistance increasing the risk, driving the need for preventive strategies. METHODS: A review of scientific articles published between (2018-2023) in PubMed was conducted. Key terms: nursing prevention, Pneumonia associated with mechanical ventilation in adults. Fourteen relevant studies were selected for analysis, looking for preventive measures of mechanical ventilation-associated pneumonia. RESULTS: Fifteen articles analyzed in the last 5 years (2018-2023), focused on prevention of mechanical ventilation-associated pneumonia. The most effective preventive measures included head-of-bed elevation, oral hygiene with chlorhexidine, subglottic suctioning, and endotracheal tube pressure control. Implementation of these strategies decreased the incidence of ventilator-associated pneumonia and improved the recovery of patients on mechanical ventilation. CONCLUSION: Ventilator-associated pneumonia represents a challenge in intensive care units, with high mortality. Preventive measures, such as bundles of care, can reduce infections and improve patient health. Nursing staff collaboration is essential for the successful implementation of preventive strategies in older patients to reduce the risks associated with mechanical ventilation and improve care in the intensive care unit.

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Section: Resultados Y Discusiónunclassified

Nursing care to prevent ventilator-associated pneumonias in adult patients

Delgado Mejía

2023

Community and Interculturality in Dialogue

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The Paediatric AirWay Suction (PAWS) appropriateness guide for endotracheal suction interventions

Schultz

Charles

Long

et al. 2022

Australian Critical Care

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Background/objective: Endotracheal suction is an invasive and potentially harmful technique used for airway clearance in mechanically ventilated children. Choice of suction intervention remains a complex and variable process. We sought to develop appropriate use criteria for endotracheal suction interventions used in paediatric populations. Methods: The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop the Paediatric AirWay Suction appropriateness guide. This included defining key terms, synthesising current evidence, engaging an expert multidisciplinary panel, case scenario development, and two rounds of appropriateness ratings (weighing harm with benefit). Indications (clinical scenarios) were developed from common applications or anticipated use, current practice guidelines, clinical trial results, and expert consultation. Results: Overall, 148 (19%) scenarios were rated as appropriate (benefit outweighs harm), 542 (67%) as uncertain, and 94 (11%) as inappropriate (harm outweighs benefit). Disagreement occurred in 24 (3%) clinical scenarios, namely presuction and postsuction bagging across populations and age groups. In general, the use of closed suction was rated as appropriate, particularly in the subspecialty population 'patients with highly infectious respiratory disease'. Routine application of 0.9% saline for nonrespiratory indications was more likely to be inappropriate/uncertain than appropriate. Panellists preferred clinically indicated suction versus routine suction in most circumstances. Conclusion: Appropriate use criteria for endotracheal suction in the paediatric intensive care have the potential to impact clinical decision-making, reduce practice variability, and improve patient outcomes.

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

Schultz¹,

Charles²,

Long³

et al. 2022

Australian Critical Care

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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.

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Normal saline and lung recruitment with paediatric endotracheal suction (NARES): A pilot, factorial, randomised controlled trial

Cited by 5 publications

References 49 publications

Nursing care to prevent ventilator-associated pneumonias in adult patients

Nursing care to prevent ventilator-associated pneumonias in adult patients

The Paediatric AirWay Suction (PAWS) appropriateness guide for endotracheal suction interventions

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

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