Updating the evidence-base for suctioning adult patients: a systematic review

Abstract

Objectives: To update a previous clinical practice guideline on suctioning in adult patients, published in the Canadian Respiratory Journal in 2001.

Methods: A primary search of the MEDLINE (from 1998), CINAHL, EMBASE and The Cochrane Library (all from 1996) databases up to November 2007, was conducted. These dates reflect the search limits reached in the previous clinical practice guideline. A secondary search of the reference lists of retrieved articles was also performed. Two reviewers independently appraised each study before meeting to reach consensus. Study quality was evaluated using the Jadad and PEDro scales. When sufficient data were available, a meta-analysis was conducted using a random effects model. Data are reported as ORs, weighted mean differences and 95% CIs. When no comparisons were possible, qualitative analyses of the data were completed.

Results: Eighty-one studies were critically appraised from a pool of 123. A total of 28 randomized controlled trials or randomized crossover studies were accepted for inclusion. Meta-analysis was possible for open versus closed suctioning only. Recommendations from 2001 with respect to hyperoxygenation, hyperinflation, use of a ventilator circuit adaptor and subglottic suctioning were confirmed. New evidence was identified with respect to indications for suctioning, open suction versus closed suction systems, use of medications and infection control.

Conclusions: While new evidence continues to be varied in strength, and is still lacking in some areas of suctioning practice, the evidence base has improved since 2001. Members of the health care team should incorporate this evidence into their practice.

Figures

Figure 1)

Meta-analysis for open suction versus closed suction on arterial oxygen saturation (SaO2), %, without preoxygenation. No significant difference between interventions. df Degrees of freedom; WMD Weighted mean difference

Figure 2)

Meta-analysis for open suction versus closed suction on end-expiratory lung volume (EELV), without preoxygenation. Closed suction had significantly greater EELV. df Degrees of freedom; WMD Weighted mean difference

Figure 3)

Meta-analyses for open suction versus closed suction on ventilator-associated pneumonia (VAP). Top analysis: number of patients with ventilator-assisted pneumonia (VAP). Bottom analysis: Incidence of VAP per 1000 patient days. No significant difference between interventions. df Degrees of freedom; N Number of patients in the group; n Number of patients with VAP; pts Patients