Implementing paediatric appropriate use criteria for endotracheal suction to reduce complications in mechanically ventilated children with respiratory infections

BackgroundEndotracheal suction is used to maintain endotracheal tube patency. There is limited guidance to inform clinical practice for children with respiratory infections.ObjectiveThe objective of this study was to determine whether implementation of a paediatric endotracheal suction appropriate use guideline Paediatric AirWay Suction (PAWS) is associated with an increased use of appropriate and decreased use of inappropriate suction interventions.MethodsA mixed-method, pre-implementation–post-implementation study was conducted between September 2021 and April 2022. Suction episodes in mechanically ventilated children with a respiratory infection were eligible. Using a structured approach, we implemented the PAWS guideline in a single paediatric intensive care unit. Evaluation included clinical (e.g., suction intervention appropriateness), implementation (e.g., acceptability), and cost outcomes (implementation costs). Associations between implementation of the PAWS guideline and appropriateness of endotracheal suction intervention use were investigated using generalised linear models.ResultsData from 439 eligible suctions were included in the analysis. Following PAWS implementation, inappropriate endotracheal tube intervention use reduced from 99% to 58%, an absolute reduction (AR) of 41% (95% confidence interval [CI]: 25%, 56%). Reductions were most notable for open suction systems (AR: 48%; 95% CI: 30%, 65%), 0.9% sodium chloride use (AR: 23%; 95% CI: 8%, 38%) and presuction and postsuction manual bagging (38%; 95% CI: 16%, 60%, and 86%; 95% CI: 73%, 99%), respectively. Clinicians perceived PAWS as acceptable and suitable for use.ConclusionsImplementation of endotracheal tube suction appropriate use guidelines in a mixed paediatric intensive care unit was associated with a large reduction in inappropriate suction intervention use in paediatric patients with respiratory infections

Dressings and securement devices to prevent complications for peripheral arterial catheters

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To compare the effectiveness of dressings and securement devices for peripheral arterial catheters

Benthic macrofauna, sediment and water quality near seafood cannery outfalls in Yaquina Bay, Oregon

"Seafood canneries in lower Yaquina Ray, Oregon process shrimp (Pandalus jordani), Dungeness crab (Cancer magister), a variety of bottom fish and several salmon species. The shrimp wastes are screened and discharged directly into the Ray beneath the cannery docks. During the shrimp processing season about 3.8 million liters of wastes are discharged daily. We conducted a survey of the macrohenthos, sediment, and water quality in Yaquina Bay in May 1978. The effects of the cannery wastes were restricted to the immediate vicinity of the cannery docks. The effluent plume was quite turbid and had high nutrient concentrations. Because of its initial low salinity it was restricted to the surface layer where it mixed with estuarine water and was rapidly dispersed by strong tidal currents. Dissolved oxygen concentrations were 7.0 mg/1 or greater in the plume. The strong currents and screening treatment of the effluent minimized deposition of solids on the sea bed. Bottom water quality was not adversely affected." (from the Abstract) Includes species list

Normal Saline and Lung Recruitment With Paediatric Endotracheal Suction:A Review and Critical Appraisal of Practice Recommendations

Background: Normal saline instillation (NSI) and lung recruitment manoeuvres (RMs) are used in conjunction with endotracheal suction (ETS) in mechanically ventilated children. Practice is varied, and it is not currently understoodwhat clinical practice guidelines (CPGs) are available to inform practice decisions. Objective: The aimof this studywas to identify and systematically reviewthe quality of existing ETS CPGs, specifically in the context of NSI and RM use. Methods: A systematic search for ETS CPGs in children (<18 years old) was conducted in Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, EMBASE, and Google Scholar. Two independent assessors evaluated CPGs using the Appraisal of Guidelines for Research and Evaluation II instrument. Standardised scores were calculated for individual CPGs, and scale domain scores were calculated. Results: Four CPGs and practice recommendations from 2 literature reviews were identified and evaluated. The routine use of NSI and RMs with paediatric ETS was not recommended. Recommendations reflected the low quality and limited availability of evidence to inform NSI and RM application. Collectively, the highest scoring domain was clarity of presentation, followed by scope and purpose (78). Overall assessments ranged from 8 to 100 from a possible 100 points. Four ETS CPGs (100%) were recommended for use with modification. Conclusions: Clinical practice guidelines and practice recommendations pertaining to NSI and RM were consistent but, however, limited by the quality and volume of available evidence. Clinical practice guideline developers should focus on improving the applicability and rigour in development processes. Further consensus work and rigorous trials are needed to inform future CPGs. </p

Endotracheal suction interventions in mechanically ventilated children: an integrative review to inform evidence-based practice

Objective: The objective of this study was to review and critically appraise the evidence for paediatric endotracheal suction interventions. Data sources: A systematic search for studies was undertaken in the electronic databases CENTRAL, Medline, EMBASE, and EBSCO CINAHL from 2003. Study selection: Included studies assessed suction interventions in children (≤18 ys old) receiving mechanical ventilation. The primary outcome was defined a priori as duration of mechanical ventilation. Secondary outcomes included adverse events and measures of gas exchange and lung mechanics. Data extraction: Data extraction were performed independently by two reviewers. Study methodological quality was assessed using Cochrane's risk of bias tool for randomised trials or the Newcastle–Ottawa Scale for observational studies. Overall assessment of the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations criteria. Results: Overall 17 studies involving 1618 children and more than 21,834 suction episodes were included in the review. The most common intervention theme was suction system (five studies; 29%). All included trials were at unclear or high risk of performance bias due to the inability to blind interventionists. Current evidence suggests that closed suction may maintain arterial saturations, normal saline leads to significant transient desaturation, and lung recruitment applied after suction offers short-term oxygenation benefit. Limitations: Lack of randomised controlled trials, inconsistencies in populations and interventions across studies, and imprecision and risk of bias in included studies precluded data pooling to provide an estimate of interventions effect. Conclusions: Based on the results of this integrative review, there is insufficient high-quality evidence to guide practice around suction interventions in mechanically ventilated children