Intervention of nursing staff in the elimination of secretions in critically ill patients:
Keywords:
airway suctioning, critical care nursing, secretion clearance, mechanical ventilation, ventilator-associated pneumonia, patient safety.Abstract
Safe secretion clearance in critically ill patients requires clinical decisions regarding indications, suction technique, complication prevention, and complementary airway-hygiene strategies. This integrative review synthesized evidence published from 2018 to 2022 relevant to nursing interventions in patients with artificial airways and mechanical ventilation. Evidence was organized into six domains: indications and suction safety, open versus closed systems, saline instillation, oral hygiene and ventilator-associated pneumonia prevention, subglottic secretion drainage, and professional knowledge/adherence. The 2022 AARC guideline provides the most comprehensive technical framework, supporting clinically indicated suctioning, preoxygenation, catheter-size and suction-duration limits, sterile technique for open suctioning, and general avoidance of normal saline. Available evidence does not establish universal clinical superiority of open or closed systems; subglottic secretion drainage reduces ventilator-associated pneumonia, and oral hygiene contributes to multimodal prevention. Practice studies identify substantial gaps between knowledge and performance. Nursing care should therefore be structured as a clinical process of assessment, safe execution, infection prevention, and adherence monitoring rather than routine suctioning without indication.
References
1. Blakeman, T. C., Scott, J. B., Yoder, M. A., Capellari, E., & Strickland, S. L. (2022). AARC Clinical Practice Guidelines: Artificial airway suctioning. Respiratory Care, 67(2), 258–271. https://doi.org/10.4187/respcare.09548
2. Zhao, T., Wu, X., Zhang, Q., Li, C., Worthington, H. V., & Hua, F. (2020). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database of Systematic Reviews, 2020(12), CD008367. https://doi.org/10.1002/14651858.CD008367.pub4
3. Pozuelo-Carrascosa, D. P., Herráiz-Adillo, Á., Álvarez-Bueno, C., Añón, J. M., Martínez-Vizcaíno, V., & Cavero-Redondo, I. (2020). Subglottic secretion drainage for preventing ventilator-associated pneumonia: An overview of systematic reviews and an updated meta-analysis. European Respiratory Review, 29(155), 190107. https://doi.org/10.1183/16000617.0107-2019
4. Mwakanyanga, E. T., Masika, G. M., & Tarimo, E. A. M. (2018). Intensive care nurses’ knowledge and practice on endotracheal suctioning of the intubated patient: A quantitative cross-sectional observational study. PLoS ONE, 13(8), e0201743. https://doi.org/10.1371/journal.pone.0201743
5. Chen, W., Hu, S., Liu, X., et al. (2021). Intensive care nurses’ knowledge and practice of evidence-based recommendations for endotracheal suctioning: A multisite cross-sectional study in Changsha, China. BMC Nursing, 20, 186. https://doi.org/10.1186/s12912-021-00715-y
6. Alkubati, S. A., Al-Sayaghi, K. M., Alrubaiee, G. G., et al. (2022). Adherence of critical care nurses to endotracheal suctioning guidelines: A cross-sectional study. BMC Nursing, 21, 312. https://doi.org/10.1186/s12912-022-01092-w
7. Hassan, E. A., & Elsaman, S. E. A. (2022). Relationship between ventilator bundle compliance and the occurrence of ventilator-associated events: A prospective cohort study. BMC Nursing, 21, 207. https://doi.org/10.1186/s12912-022-00997-w
8. Shadvar, K., Sanaie, S., Mahmoodpoor, A., Rahnemayan, S., Javan, S. B., & Saghaleini, S. (2022). Comparison of closed vs open suction in prevention of ventilator-associated pneumonia: A systematic review and meta-analysis. Indian Journal of Critical Care Medicine, 26(7), 839–845. https://doi.org/10.5005/jp-journals-10071-24252
9. Tembhare, V., & Singh, S. (2021). Effectiveness of protocol on endotracheal tube suctioning among ICU staff nurses. International Journal of Current Research and Review, 13(8), 71–75. https://doi.org/10.31782/ijcrr.2021.13831
10. Swingwood, E., Stilma, W., Tume, L. N., et al. (2022). The use of mechanical insufflation-exsufflation in invasively ventilated critically ill adults. Respiratory Care, 67(8), 1043–1057. https://doi.org/10.4187/respcare.09704
11. Jang, M. H., Shin, M., & Shin, Y. B. (2019). Pulmonary and physical rehabilitation in critically ill patients. Acute and Critical Care, 34(1), 1–13. https://doi.org/10.4266/acc.2019.00444
12. Lachérade, J.-C., Azaïs, M.-A., Pouplet, C., & Colin, G. (2018). Subglottic secretion drainage for ventilator-associated pneumonia prevention: An underused efficient measure. Annals of Translational Medicine, 6(20), 422. https://doi.org/10.21037/atm.2018.10.40
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Copyright (c) 2023 Paulina I. Armas Freire (Autor/a)
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