Recommendations for endotracheal suction interventions in children with highly infectious respiratory disease: Results from a RAND/UCLA binational appropriateness panel
Dr Jessica Schults1,2,3,4, Ms Karina Charles3,4, A/Prof Debbie Long4,5, Dr Simon Erikson6, Dr Adam Irwin8,9, Dr Michaela Waak4, A/Prof Lisa Hall10, Professor Amanda Ullman1,7
1University of Queensland, School of Nursing, Midwifery and Social Work , Brisbane, Australia
2Herston Infectious Diseases Institute (HEiDI), Metro North Hospital and Health Service, Brisbane , Australia
3School of Nursing and Midwifery, Griffith University, Nathan, Australia
4Paediatric Intensive Care, Queensland Children’s Hospital, South Brisbane, Australia
5School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
6Paediatric Critical Care Unit, Perth Children’s Hospital, Perth, Australia
7Children’s Health Queensland Hospital and Health District, Brisbane, Australia
8Infection Management and Prevention Service Queensland Children’s Hospital, Brisbane, Australia
9University of Queensland, Centre for Clinical Research, Brisbane, Australia
10School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
Introduction: Endotracheal suction is an invasive and potentially harmful technique used for airway clearance in mechanically ventilated children. Choice of suction intervention remains a complex and variable process, particularly where there are risks posed to staff. We sought to develop appropriate use criteria (AUC) for endotracheal suction interventions used in children with highly infectious respiratory disease.
Methods: The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop the Paediatric AirWay Suction – PAWS appropriateness guide. This included defining key terms, synthesising current evidence, engaging an expert multidisciplinary panel, case scenario development, and 2 rounds of appropriateness ratings (weighing harm with benefit). Indications (clinical scenarios) were developed from common applications or anticipated use, current practice guidelines, clinical trial results and expert consultation.
Results: Overall, in children with highly infectious respiratory disease, across patient age and indication for suction 1 intervention – closed suction system, was rated as appropriate (benefit outweighs harm), 3 interventions as uncertain (pre- and post-oxygenation and lung recruitment), and 4 interventions rated as inappropriate (harm outweighs benefit; pre and pot-bagging, open suction and saline instillation). No disagreement occurred between panellists. Panellists preferred clinically indicated suction versus routine suction in most circumstances.
Conclusion: AUC for endotracheal suction in the Paediatric Intensive Care have the potential to impact clinical decision making, reduce practice variability and improve patient and safety. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research.
This work was support by the Australian College of Critical Care Nurses and The Children’s Hospital Foundation.
Biography:
Jessica Schults is a senior research fellow with The University of Queensland and the Herston Infectious Disease Institute at Metro North Hospital and Health Service. She is interested in building our digital health capacity to monitor and predict hospital associated infections.