Jessica A. Schults, PhD, RN, is research fellow, Department of Anaesthesia and Pain Management, Queensland Children's Hospital; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University; and Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia. Marie Cooke, PhD, RN, is professor of nursing, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia. Debbie A. Long, PhD, RN, is associate professor and paediatric intensive care nurse researcher, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University; Paediatric Intensive Care Unit, Queensland Children's Hospital; and Paediatric Critical Care Research Group, The University of Queensland, Australia. Marion L. Mitchell, PhD, RN, is professor of critical care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University; and Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia.
Dimens Crit Care Nurs. 2020 Nov/Dec;39(6):321-328. doi: 10.1097/DCC.0000000000000442.
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 understood what clinical practice guidelines (CPGs) are available to inform practice decisions.
The aim of this study was to identify and systematically review the quality of existing ETS CPGs, specifically in the context of NSI and RM use.
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.
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.
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.
生理盐水灌洗（NSI）和肺复张手法（RMs）与气管内吸引（ETS）联合应用于机械通气的儿童。实践方法多样，目前尚不清楚有哪些临床实践指南（CPGs）可以为实践决策提供信息。
本研究旨在确定并系统评价现有的 ETS 临床实践指南的质量，特别是在 NSI 和 RM 使用方面。
系统检索儿童（<18 岁）的 ETS 临床实践指南，检索范围包括 Cumulative Index to Nursing and Allied Health Literature、MEDLINE、PubMed、EMBASE 和 Google Scholar。两名独立评估员使用 Appraisal of Guidelines for Research and Evaluation II 工具评估 CPGs。为每个 CPG 计算标准化评分，并计算量表域评分。
确定并评价了 4 项 CPG 和 2 项文献综述中的实践建议。不建议常规使用 NSI 和 RMs 联合儿科 ETS。这些建议反映了 NSI 和 RM 应用的证据质量低且有限。总体而言，评分最高的领域是表述清晰度，其次是范围和目的（78）。总体评估范围从可能的 100 分中的 8 分到 100 分不等。有 4 项 ETS 临床实践指南（100%）建议在修改后使用。
关于 NSI 和 RM 的临床实践指南和实践建议是一致的，但受到可用证据的质量和数量的限制。临床实践指南制定者应专注于提高适用度和开发过程的严谨性。需要进一步的共识工作和严格的试验来为未来的 CPGs 提供信息。
