Morrow Brenda M, Argent Andrew C
Division of Paediatric Critical Care and Children's Heart Disease, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. brenda.morrowuct.ac.za
Pediatr Crit Care Med. 2008 Sep;9(5):465-77. doi: 10.1097/PCC.0b013e31818499cc.
To provide a comprehensive, evidence-based review of pediatric endotracheal suctioning: effects, indications, and clinical practice.
PubMed, Cumulative Index of Nursing and Allied Health Literature, and PEDro (Physiotherapy Evidence Database) electronic databases were searched for English language articles, published between 1962 and June 2007. Owing to the paucity of objective pediatric data, all reports dealing with this topic were examined, including adult and neonatal studies.
One hundred eighteen references were included in the final review. Despite the widespread use of endotracheal suctioning, very little high-level evidence dealing with pediatric endotracheal suctioning exists. Studies of mechanically ventilated neonatal, pediatric, and adult patients have shown that suctioning causes a range of potentially serious complications. Current practice guidelines are not based on evidence from controlled clinical trials. There is no clear evidence that endotracheal suctioning improves respiratory mechanics, with most studies pointing to the detrimental effect it has on lung mechanics. Suctioning should be performed when obstructive secretions are present rather than routinely. There is no clear evidence for the superiority of closed- or open-system suctioning, nor is there clear evidence for appropriate vacuum pressures and suction catheter size. Sterility does not seem to be necessary when suctioning. Preoxygenation has short-term benefits, but the longer-term impact is unknown. Routine saline instillation before suctioning should not be performed. Recruitment maneuvers performed after suctioning have not been shown to be useful as standard practice.
Endotracheal suctioning is a procedure used regularly in the pediatric intensive care unit. Despite this, good evidence supporting its practice is limited. Further, controlled clinical studies are needed to develop evidence-based protocols for endotracheal suctioning of infants and children, and to examine the impact of different suctioning techniques on the duration of ventilatory support, incidence of nosocomial infection, and length of pediatric intensive care unit and hospital stay.
对小儿气管内吸引术的效果、适应证及临床实践进行全面的、基于证据的综述。
检索了PubMed、护理学与健康相关文献累积索引以及PEDro（物理治疗证据数据库）电子数据库，查找1962年至2007年6月期间发表的英文文章。由于缺乏客观的儿科数据，所有涉及该主题的报告均进行了审查，包括成人和新生儿研究。
最终综述纳入了118篇参考文献。尽管气管内吸引术被广泛使用，但关于小儿气管内吸引术的高水平证据却很少。对机械通气的新生儿、儿童和成人患者的研究表明，吸引会引发一系列潜在的严重并发症。当前的实践指南并非基于对照临床试验的证据。没有明确证据表明气管内吸引能改善呼吸力学，大多数研究指出其对肺力学有不利影响。当存在阻塞性分泌物时应进行吸引，而非常规操作。没有明确证据表明封闭式或开放式吸引系统更具优势，也没有明确证据表明合适的负压和吸引导管尺寸。吸引时似乎无需保持无菌。预充氧有短期益处，但长期影响未知。不应在吸引前常规注入生理盐水。吸引后进行的肺复张手法作为标准操作尚未显示出有用性。
气管内吸引术是儿科重症监护病房经常使用的一项操作。尽管如此，支持其应用的充分证据有限。此外，需要进行对照临床研究，以制定基于证据的婴幼儿和儿童气管内吸引方案，并研究不同吸引技术对通气支持时间、医院感染发生率以及儿科重症监护病房住院时间和住院总时长的影响。
