Mechanical ventilation and the role of saline instillation in suctioning adult intensive care unit patients: an evidence-based practice review

Abstract

Background: Saline instillation in suctioning mechanically ventilated patients remains a common practice in the intensive care unit (ICU). Many respiratory therapists and nurses are using saline with suctioning without an adequate knowledge of the current evidence-based research to guide this practice.

Objectives: The purpose of this study was to determine if this routine method is beneficial or harmful to the patients and provide evidence-based practice recommendations that will serve as a guide for practice.

Methods: This is a comprehensive review on the use of saline instillation in suctioning mechanically ventilated adult ICU patients. Database such as CINAHL, MEDLINE, Cochrane, PsycINFO, and national guidelines are extracted for the review of literature. The study population consists of patients 18 years or older, who are intubated or have a tracheostomy in place, requiring mechanical ventilation, and who are admitted in the ICU.

Results: Although most of the evidence suggests not to use saline when suctioning, there are various limitations to the studies such as small sample size, settings, inconsistencies in data collection, or not enough or outdated research clinical trials, which calls for further studies.

Conclusion: This study does not support the use of saline instillation when suctioning an artificial airway. Further clinical trials are crucial to effectively determine if saline instillation use with suctioning an artificial airway is deemed harmful, which can be strictly enforced as a mandatory clinical guideline for all hospitals to include in their standardized protocol to not use saline instillation with suctioning.