A Meta analysis on effects of different sputum suction time_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HUO Shaojuan ^1,2 , TIAN Jinhui ³ , ZENG Xiaoli ² , LI Fei ² , ZHOU Linlin ¹ , SU Yan ¹ ,  LIU Xiaoju ²

1. College of Nursing, Lanzhou University, Lanzhou, Gansu 730000, P. R. China;
2. Department of Geratological Respiratory Medicine, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P. R. China;
3. Evidence-based Medicine Center, Lanzhou University, Lanzhou, Gansu 730000, P. R. China;

Corresponding?author：

LIU Xiaoju, Email: liuxiaoju835@126.com

Keywords：

Time-worn ritual endotracheal suction; On-demand invasive airway suction; Meta-analysis

DOI：

10.7507/1671-6205.201809044

Video：

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Objective To analyze the effects of time-worn ritual endotracheal suction (TRES) and on-demand invasive airway suction (OIAS) for patients.Methods PubMed, EMBASE, Cochrane Library, Web of Science, EBSCO, CBM, CNKI, WanFang and VIP databases were searched for all randomized controlled trials (RCTs) comparing TRES with OIAS for patients. The studies were selected according to inclusion and exclusion criteria. The articles were assessed and data were extracted from them. The RevMan 5.3 software was used to analyze the data.Results Seventeen randomized controlled trials were included finally, and 2 029 patients were included, involving 1 028 patients in the control group and 1 001 patients in the experimental group. The results of meta-analysis showed that compared with TRES, OIAS could reduce the damage to the airway mucosa injury (RR=0.18, 95%CI 0.13 - 0.26, P<0.000 01), reduce secondary respiratory infections (RR=0.44, 95%CI 0.30 - 0.65, P<0.000 1), decrease the occurrence of phlegm blockade (RR=0.20, 95%CI 0.13 - 0.33, P<0.000 01), shorten the hospital stay (MD=5.03, 5%CI 3.17 - 6.89, P<0.000 01), but not influence the drop in oxygen saturation and the drop in blood oxygen pressure (RR=0.50, 95%CI 0.21 - 1.17, P=0.11). However there was no significant difference in mortality between two groups (P=0.46).Conclusion OIAS is preferred for patients who need suction than TRES.

Citation： HUO Shaojuan, TIAN Jinhui, ZENG Xiaoli, LI Fei, ZHOU Linlin, SU Yan, LIU Xiaoju. A Meta analysis on effects of different sputum suction time. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(5): 461-468. doi: 10.7507/1671-6205.201809044 Copy

1.	American Association for Respiratory Care. AARC Clinical Practice Guidelines. Endotracheal Suctioning of Mechanically Ventilated Patients with Artificial Airways 2010. Respir Care, 2010, 55(6): 758-764.
2.	李秀萍, 鄭湘毅. 背心式高頻振動排痰與機械振動排痰對老年肺部感染患者的效果觀察. 中國呼吸與危重監護雜志, 2017, 16(3): 241-244.
3.	Riiser C, Stenkj?r RL, Nystrand S. Development and implementation of evidence based clinical guideline regarding endotracheal suctioning of the intubated neonate. Arch Dis Child, 2014, 99(Suppl 2): A535.
4.	Bruschettini M, Zappettini S, Moja L, et al. Frequency of endotracheal suctioning for the prevention of respiratory morbidity in ventilated newborns. Cochrane Database Syst Rev, 2016, 3: CD011493.
5.	魏麗麗, 韓斌如, 王軍. 機械通氣患者按需吸痰的研究進展. 西南國防醫藥, 2018, 28(1): 92-94.
6.	Wood CJ. Can nurses safely assess the need for endotracheal suction in short-term ventilated patients, instead of using routine techniques?. Intensive Crit Care Nurs, 1998, 14(4): 170-178.
7.	王冬, 蔣嘉麗. 按時吸痰 or 按需吸痰. 齊齊哈爾醫學院學報, 2012, 33(16): 2284-2285.
8.	李思媛. 120 例 ICU 氣管插管患者按需吸痰護理干預的效果觀察. 醫藥衛生 (全文版), 2016, 42(4): 42.
9.	Van de Leur JP, Zwaveling JH, Loef BG, et al. Patient recollection of airway suctioning in the ICU: routine versus a minimally invasive procedure. Intensive Care Med, 2003, 29(3): 433-436.
10.	Van de Leur JP, Zwaveling JH, Loef BG, et al. Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: a prospective randomised controlled trial. Intensive Care Med, 2003, 29(3): 426-432.
11.	康慧. 解析非定時吸痰技術及護理對氣管切開患者的影響. 大家健康 (學術版), 2012, 6(7): 8-9.
12.	徐林鳳. 非定時吸痰技術及護理對氣管切開患者的效果評價. 吉林醫學, 2014, 35(12): 2712-2713.
13.	龐林薇. 非定時吸痰技術及護理對氣管切開患者的干預作用分析. 世界臨床醫學, 2015, 9(4): 215.
14.	鄧業芹, 許業梅, 沈佩君. 新生兒人工氣道吸痰時機的研究. 臨床護理雜志, 2012, 11(6): 28-29.
15.	莫蘭. 不同吸痰時機對新生兒機械通氣治療的護理觀察. 中國現代藥物應用, 2015, 9(13): 190-192.
16.	張蔚. 不同吸痰方式對早產兒機械通氣效果及并發癥的影響. 臨床兒科雜志, 2008, 26(3): 195-196.
17.	胡秀芬, 閆碩, 周文平. 分時護理在肺癌手術患者術后機械吸痰護理中的應用研究. 實用臨床醫藥雜志, 2015, 19(16): 64-66.
18.	周鳳芝, 王慧慧, 王勝文. 氣管插管患者吸痰護理最佳時機探討. 中國醫藥指南, 2013, 11(3): 636.
19.	李智慧, 郭建華, 袁藝源, 等. 神經外科氣管切開患者按需吸痰護理效果評價. 實用醫院臨床雜志, 2015, 12(5): 198-200.
20.	許金嬌, 何友云. 顱腦損傷氣管切開病人吸痰時機的探討. 全科護理, 2012, 10(3B): 698-699.
21.	卓雅淑, 林義清. 按需吸痰對氣管切開患者并發肺炎的影響. 現代醫院, 2007, 7(5): 81.
22.	劉均. 胸外科病人氣管插管按需吸痰護理干預的效果觀察. 全科護理, 2014, 12(1): 58-59.
23.	Lavigne MC. Comparing suctioning techniques used to assist mechanical ventilation: Protecting you and your patients. Int J Infect Control, 2016, 12(2): 1-12.
24.	Elsaman SE. Effect of application of Endotracheal Suction Guidelines on cardiorespiratory parameters of mechanically ventilated patients. IOSR J Nurs Health Sci, 2017, 6(1): 41-48.
25.	Lema G, Fernández M, Zuleta J, et al. Differences in morbidity for as-needed endotracheal suctioning protocol vs a routine endotracheal suctioning in pediatric intensive care: a randomized controlled trial. Pediatr Crit Care Med, 2014, 15(4 Suppl): Abstract 420.
26.	Pourmand A, Lee D, Davis S, et al. Point-of-care ultrasound utilizations in the emergency airway management: an evidence-based review. Am J Emerg Med, 2017, 35(8): 1202-1206.
27.	Jongerden IP, Buiting AG, Leverstein-van Hall MA, et al. Effect of open and closed endotracheal suctioning on cross-transmission with Gram-negative bacteria: a prospective crossover study. Crit Care Med, 2011, 39(6): 1313-1321.
28.	余威英, 徐小娟, 魏凌云, 等. 呼吸機相關性肺炎感染的危險因素分析. 中華醫院感染學雜志, 2014, 24(1): 112-113, 127.
29.	Khan U, Atkinson SS, Gable B, et al. Initial validation of a modified suction task training system. Can J Respir Ther, 2015, 51(1): 13-17.
30.	Kuriyama A, Umakoshi N, Fujinaga J, et al. Impact of closed versus open tracheal suctioning systems for mechanically ventilated adults: a systematic review and meta-analysis. Intensive Care Med, 2015, 41(3): 402-411.
31.	Kohan M, Rezaei-Adaryani M, Najaf-Yarandi A, et al. Effects of expiratory ribcage compression before endotracheal suctioning on arterial blood gases in patients receiving mechanical ventilation. Nurs Crit Care, 2014, 19(5): 255-261.
32.	Davies K, Monterosso L, Bulsara M, et al. Clinical indicators for the initiation of endotracheal suction in children: an integrative review. Aust Crit Care, 2015, 28(1): 11-18.
33.	袁璐, 陳慶紅, 向利紅, 等. 吸痰時機對麻醉恢復室患者拔管時心血管反應的影響. 護理學雜志, 2018, 33(10): 56-57.

1. American Association for Respiratory Care. AARC Clinical Practice Guidelines. Endotracheal Suctioning of Mechanically Ventilated Patients with Artificial Airways 2010. Respir Care, 2010, 55(6): 758-764.
2. 李秀萍, 鄭湘毅. 背心式高頻振動排痰與機械振動排痰對老年肺部感染患者的效果觀察. 中國呼吸與危重監護雜志, 2017, 16(3): 241-244.
3. Riiser C, Stenkj?r RL, Nystrand S. Development and implementation of evidence based clinical guideline regarding endotracheal suctioning of the intubated neonate. Arch Dis Child, 2014, 99(Suppl 2): A535.
4. Bruschettini M, Zappettini S, Moja L, et al. Frequency of endotracheal suctioning for the prevention of respiratory morbidity in ventilated newborns. Cochrane Database Syst Rev, 2016, 3: CD011493.
5. 魏麗麗, 韓斌如, 王軍. 機械通氣患者按需吸痰的研究進展. 西南國防醫藥, 2018, 28(1): 92-94.
6. Wood CJ. Can nurses safely assess the need for endotracheal suction in short-term ventilated patients, instead of using routine techniques?. Intensive Crit Care Nurs, 1998, 14(4): 170-178.
7. 王冬, 蔣嘉麗. 按時吸痰 or 按需吸痰. 齊齊哈爾醫學院學報, 2012, 33(16): 2284-2285.
8. 李思媛. 120 例 ICU 氣管插管患者按需吸痰護理干預的效果觀察. 醫藥衛生 (全文版), 2016, 42(4): 42.
9. Van de Leur JP, Zwaveling JH, Loef BG, et al. Patient recollection of airway suctioning in the ICU: routine versus a minimally invasive procedure. Intensive Care Med, 2003, 29(3): 433-436.
10. Van de Leur JP, Zwaveling JH, Loef BG, et al. Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: a prospective randomised controlled trial. Intensive Care Med, 2003, 29(3): 426-432.
11. 康慧. 解析非定時吸痰技術及護理對氣管切開患者的影響. 大家健康 (學術版), 2012, 6(7): 8-9.
12. 徐林鳳. 非定時吸痰技術及護理對氣管切開患者的效果評價. 吉林醫學, 2014, 35(12): 2712-2713.
13. 龐林薇. 非定時吸痰技術及護理對氣管切開患者的干預作用分析. 世界臨床醫學, 2015, 9(4): 215.
14. 鄧業芹, 許業梅, 沈佩君. 新生兒人工氣道吸痰時機的研究. 臨床護理雜志, 2012, 11(6): 28-29.
15. 莫蘭. 不同吸痰時機對新生兒機械通氣治療的護理觀察. 中國現代藥物應用, 2015, 9(13): 190-192.
16. 張蔚. 不同吸痰方式對早產兒機械通氣效果及并發癥的影響. 臨床兒科雜志, 2008, 26(3): 195-196.
17. 胡秀芬, 閆碩, 周文平. 分時護理在肺癌手術患者術后機械吸痰護理中的應用研究. 實用臨床醫藥雜志, 2015, 19(16): 64-66.
18. 周鳳芝, 王慧慧, 王勝文. 氣管插管患者吸痰護理最佳時機探討. 中國醫藥指南, 2013, 11(3): 636.
19. 李智慧, 郭建華, 袁藝源, 等. 神經外科氣管切開患者按需吸痰護理效果評價. 實用醫院臨床雜志, 2015, 12(5): 198-200.
20. 許金嬌, 何友云. 顱腦損傷氣管切開病人吸痰時機的探討. 全科護理, 2012, 10(3B): 698-699.
21. 卓雅淑, 林義清. 按需吸痰對氣管切開患者并發肺炎的影響. 現代醫院, 2007, 7(5): 81.
22. 劉均. 胸外科病人氣管插管按需吸痰護理干預的效果觀察. 全科護理, 2014, 12(1): 58-59.
23. Lavigne MC. Comparing suctioning techniques used to assist mechanical ventilation: Protecting you and your patients. Int J Infect Control, 2016, 12(2): 1-12.
24. Elsaman SE. Effect of application of Endotracheal Suction Guidelines on cardiorespiratory parameters of mechanically ventilated patients. IOSR J Nurs Health Sci, 2017, 6(1): 41-48.
25. Lema G, Fernández M, Zuleta J, et al. Differences in morbidity for as-needed endotracheal suctioning protocol vs a routine endotracheal suctioning in pediatric intensive care: a randomized controlled trial. Pediatr Crit Care Med, 2014, 15(4 Suppl): Abstract 420.
26. Pourmand A, Lee D, Davis S, et al. Point-of-care ultrasound utilizations in the emergency airway management: an evidence-based review. Am J Emerg Med, 2017, 35(8): 1202-1206.
27. Jongerden IP, Buiting AG, Leverstein-van Hall MA, et al. Effect of open and closed endotracheal suctioning on cross-transmission with Gram-negative bacteria: a prospective crossover study. Crit Care Med, 2011, 39(6): 1313-1321.
28. 余威英, 徐小娟, 魏凌云, 等. 呼吸機相關性肺炎感染的危險因素分析. 中華醫院感染學雜志, 2014, 24(1): 112-113, 127.
29. Khan U, Atkinson SS, Gable B, et al. Initial validation of a modified suction task training system. Can J Respir Ther, 2015, 51(1): 13-17.
30. Kuriyama A, Umakoshi N, Fujinaga J, et al. Impact of closed versus open tracheal suctioning systems for mechanically ventilated adults: a systematic review and meta-analysis. Intensive Care Med, 2015, 41(3): 402-411.
31. Kohan M, Rezaei-Adaryani M, Najaf-Yarandi A, et al. Effects of expiratory ribcage compression before endotracheal suctioning on arterial blood gases in patients receiving mechanical ventilation. Nurs Crit Care, 2014, 19(5): 255-261.
32. Davies K, Monterosso L, Bulsara M, et al. Clinical indicators for the initiation of endotracheal suction in children: an integrative review. Aust Crit Care, 2015, 28(1): 11-18.
33. 袁璐, 陳慶紅, 向利紅, 等. 吸痰時機對麻醉恢復室患者拔管時心血管反應的影響. 護理學雜志, 2018, 33(10): 56-57.

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