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. 2011 Jul 6;2011(7):CD003309.
doi: 10.1002/14651858.CD003309.pub2.

Deep versus shallow suction of endotracheal tubes in ventilated neonates and young infants

Donna Gillies  1 , Kaye Spence
Affiliations

Deep versus shallow suction of endotracheal tubes in ventilated neonates and young infants

Donna Gillies et al. Cochrane Database Syst Rev. .

Abstract

Background: Mechanical ventilation is commonly used in Neonatal Intensive Care Units to assist breathing in a variety of conditions. Mechanical ventilation is achieved through the placement of an endotracheal tube (ETT) which is left in-situ. The ETT is suctioned to prevent a build-up of secretions and blockage of the airway. Methods of suctioning the endotracheal tube vary according to institutional practice and the individual clinician performing the task. The depth of suctioning is one of these variables. The catheter may be passed to the tip of the ETT or beyond the tip into the trachea or bronchi to facilitate removal of secretions. However, trauma to the lower airways may result from the suction catheter being passed into the airway beyond the tip of the endotracheal tube.

Objectives: To compare the effectiveness and complications of deep (catheter passed beyond the tip of the ETT) versus shallow (catheter passed to length of ETT only) suctioning of the endotracheal tube in ventilated infants.

Search strategy: In this first update the searches were expanded to the Cochrane Central Register of Controlled Trials (The Cochrane Library, March 30), MEDLINE (from January 1966 to May 30 2011), CINAHL (from 1982 to May 30 2011) and EMBASE (1980 to May 2011) using text words and subject headings relevant to endotracheal suctioning. There were no language restrictions.

Selection criteria: Controlled trials using random or quasi-random allocation of neonates receiving ventilatory support via an endotracheal tube to either deep or shallow endotracheal suctioning.

Data collection and analysis: The updated search resulted in 149 potentially relevant references. Two of the studies from this search were identified as potentially relevant. We included one of the potentially relevant studies and the other was excluded because it did not fit the inclusion criteria.

Main results: One small crossover trial (n = 27) of shallow versus deep suctioning met the criteria for inclusion in this review. The reported outcomes were oxygen saturation and heart rate, during and after suctioning. There were no significant differences when shallow and deep suctioning methods were compared.

Authors' conclusions: There is no evidence from randomised controlled trials concerning the benefits or risks of deep versus shallow suctioning of endotracheal tubes in ventilated neonates and infants. Further high quality research is required.

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Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 Deep versus shallow suctioning, Outcome 1 Oxygen saturation.
1.2
1.2. Analysis
Comparison 1 Deep versus shallow suctioning, Outcome 2 Heart rate.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Youngmee 2003 {published and unpublished data}
    1. Ahn Y, Hwang T. The effects of shallow versus deep endotracheal suctioning on the cytological components of respiratory aspirates in high‐risk infants. Respiration 2003;70(2):172‐8. - PubMed
    1. Youngmee A, Yonghoon J. The effects of the shallow and the deep endotracheal suctioning on oxygen saturation and heart rate in high‐risk infants. International Journal of Nursing Studies 2003;40(2):97‐104. - PubMed

Additional references

AARC 2010
    1. American Association for Respiratory Care. AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respiratory Care 2010;55(6):758‐64. - PubMed
Bailey 1988
    1. Bailey C, Kattwinkel J, Teja K, Buckley T. Shallow versus deep endotracheal suctioning in young rabbits: pathologic effects on the tracheobronchial wall. Pediatrics 1988;82(5):746‐51. - PubMed
Boothroyd 1996
    1. Boothroyd AE, Murthey BV, Darbyshire A, Petros AJ. Endotracheal suctioning causes right upper lobe collapse in intubated children. Acta Paediatrica 1996;85(12):1422‐5. - PubMed
Brodsky 1987
    1. Brodsky L, Reidy M, Stanievich JF. The effects of suctioning techniques on the distal mucosa in intubated low birth weight infants. International Journal of Pediatric Otorhinolaryngology 1987;14(1):1‐4. - PubMed
Cameron 2000
    1. Cameron J, Haines J. Management of Respiratory Disorders. In: Boxwell G editor(s). Neonatal Intensive Care Nursing. London: Routledge, 2000:96‐124.
Copnell 1995
    1. Copnell B, Fergusson D. Endotracheal suctioning: time‐worn ritual or timely intervention?. American Journal of Critical Care 1995;4(2):100‐5. - PubMed
Darlow 1997
    1. Darlow BA, Sluis KB, Inder TE, Winterbourn CC. Endotracheal suctioning of the neonate: comparison of two methods as a source of mucous material for research. Pediatric Pulmonology 1997;23(3):217‐21. - PubMed
Durand 1989
    1. Durand M, Sangha B, Cabal LA, Hoppenbrouwers T, Hodgman JE. Cardiopulmonary and intracranial pressure changes related to endotracheal suctioning in preterm infants. Critical Care Medicine 1989;17(6):506‐10. - PubMed
Gardner 2009
    1. Gardner DL, Shirland L. Evidence‐based guideline for suctioning the intubated neonate and infant. Neonatal Network ‐ Journal of Neonatal Nursing 2009;28(5):281‐302. - PubMed
Grylack 1984
    1. Grylack LJ, Anderson KD. Diagnosis and treatment of traumatic granuloma in tracheobronchial tree of newborn with history of chronic intubation. Journal of Pediatric Surgery 1984;19(2):200‐1. - PubMed
Gunderson 1986
    1. Gunderson LP, McPhee AJ, Donovan EF. Partially ventilated endotracheal suction. Use in newborns with respiratory distress syndrome. American Journal of Diseases of Children 1986;140(5):462‐5. - PubMed
Harling 2000
    1. Harling E. Diagnostic and Therapeutic Procedures. In: Boxwell G editor(s). Neonatal Intensive Care Nursing. London: Routledge, 2000:285‐314.
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hodge 1991
    1. Hodge D. Endotracheal suctioning and the infant: a nursing care protocol to decrease complications. Neonatal Network 1991;9(5):7‐13. - PubMed
Jaw 1991
    1. Jaw MC, Soong WJ, Chen SJ, Hwang B. Pneumothorax: a complication of deep endotracheal tube suction: report of 3 cases. Chinese Medical Journal 1991;48(4):313‐7. - PubMed
Knox, 1993
    1. Knox AM. Performing endotracheal suction on children: a literature review and implications for nursing practice. Intensive and Critical Care Nursing 1993;9(1):48‐54. - PubMed
Miller 1981
    1. Miller KE, Edwards DK, Hilton S, Collins D, Lynch F, Williams R. Acquired lobar emphysema in premature infants with bronchopulmonary dysplasia: An iatrogenic disease?. Radiology 1981;138(3):589‐92. - PubMed
Morrow 2008
    1. Morrow BM, Argent AC. A comprehensive review of pediatric endotracheal suctioning: Effects, indications, and clinical practice. Pediatric Critical Care Medicine 2008;9(5):465‐77. - PubMed
Pollard 2001
    1. Pollard C. Endotracheal suction in the infant with an artificial airway. Nursing in Critical Care 2001;6(2):76‐82.
Runton 1992
    1. Runton N. Suctioning artificial airways in children: appropriate technique. Pediatric Nursing 1992;18(2):115‐8. - PubMed
Shorten 1991
    1. Shorten DR, Byrne PJ, Jones RL. Infant responses to saline instillations and endotracheal suctioning. JOGNN 1991;20(6):464‐9. - PubMed
Simbruner 1981
    1. Simbruner G, Coradello H, Foder M, Havelec L, Lubec G, Pollak A. Effect of tracheal suction on oxygenation, circulation, and lung mechanics in newborn infants. Archives of Disease in Childhood 1981;56(5):326‐30. - PMC - PubMed
Sturges 1979
    1. Sturgess JM. Mucous secretions in the respiratory tract. Pediatric Clinics of North America 1979;26(3):481‐501. - PubMed
Thambiran 1966
    1. Thambiran AK, Ripley SH. Observations on tracheal trauma following suction: an experimental study. British Journal of Anaesthesia 1966;38(6):459‐62. - PubMed
Tolles 1990
    1. Tolles CL, Stone K. National survey of neonatal endotracheal suctioning procedures. Neonatal Network 1990;9(2):7‐14. - PubMed
Wrightson 1999
    1. Wrightson DD. Suctioning smarter: answers to eight common questions about endotracheal suctioning in neonates. Neonatal Network 1999;18(1):51‐5. - PubMed
Young 1995
    1. Young J. To help or hinder: endotracheal suction and the intubated neonate. Journal of Neonatal Nursing 1995;1:23‐8.

References to other published versions of this review

Spence 2003
    1. Spence K, Gillies D, Waterworth L. Deep versus shallow suction of endotracheal tubes in ventilated neonates and young infants. Cochrane Database of Systematic Reviews 2003, Issue 3. [DOI: 10.1002/14651858.CD003309] - DOI - PubMed

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