Implementing paediatric appropriate use criteria for endotracheal suction to reduce complications in mechanically ventilated children with respiratory infections

Jessica A Schults; Karina R Charles; Jane Harnischfeger; Robert S Ware; Ruth H Royle; Joshua M Byrnes; Debbie A Long; Amanda J Ullman; Sainath Raman; Michaela Waak; Anna Lake; Marie Cooke; Adam Irwin; Lyvonne Tume; Lisa Hall

doi:10.1016/j.aucc.2023.09.008

Implementing paediatric appropriate use criteria for endotracheal suction to reduce complications in mechanically ventilated children with respiratory infections

Aust Crit Care. 2024 Jan;37(1):34-42. doi: 10.1016/j.aucc.2023.09.008. Epub 2023 Dec 22.

Authors

Jessica A Schults¹, Karina R Charles², Jane Harnischfeger³, Robert S Ware⁴, Ruth H Royle⁵, Joshua M Byrnes⁶, Debbie A Long⁷, Amanda J Ullman⁸, Sainath Raman⁹, Michaela Waak⁹, Anna Lake¹⁰, Marie Cooke¹¹, Adam Irwin¹², Lyvonne Tume¹³, Lisa Hall¹⁴

Affiliations

¹ Metro North Health, Herston Infectious Disease Institute, Queensland, Australia; The University of Queensland, School of Nursing Midwifery and Social Work, Australia; The University of Queensland, Children's Health Research Centre, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia. Electronic address: j.schults@uq.edu.au.
² The University of Queensland, School of Nursing Midwifery and Social Work, Australia; The University of Queensland, Children's Health Research Centre, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia.
³ The University of Queensland, School of Nursing Midwifery and Social Work, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia.
⁴ Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Medicine and Dentistry, Griffith University, Queensland, Australia.
⁵ Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
⁶ Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Australia.
⁷ The University of Queensland, Children's Health Research Centre, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia.
⁸ The University of Queensland, School of Nursing Midwifery and Social Work, Australia; The University of Queensland, Children's Health Research Centre, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Children's Health Queensland Hospital and Health Service, Queensland, Australia.
⁹ The University of Queensland, Children's Health Research Centre, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia.
¹⁰ The University of Queensland, Children's Health Research Centre, Australia.
¹¹ School of Nursing & Midwifery, Griffith University, Australia.
¹² The University of Queensland, Centre for Clinical Research, The University of Queensland, Queensland, Australia; Infection Management and Prevention Service, Queensland Children's Hospital, Queensland, Australia.
¹³ Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK; Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK.
¹⁴ Metro North Health, Herston Infectious Disease Institute, Queensland, Australia; School of Public Health, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia.

PMID: 38142148
DOI: 10.1016/j.aucc.2023.09.008

Abstract

Background: Endotracheal suction is used to maintain endotracheal tube patency. There is limited guidance to inform clinical practice for children with respiratory infections.

Objective: The objective of this study was to determine whether implementation of a paediatric endotracheal suction appropriate use guideline Paediatric AirWay Suction (PAWS) is associated with an increased use of appropriate and decreased use of inappropriate suction interventions.

Methods: A mixed-method, pre-implementation-post-implementation study was conducted between September 2021 and April 2022. Suction episodes in mechanically ventilated children with a respiratory infection were eligible. Using a structured approach, we implemented the PAWS guideline in a single paediatric intensive care unit. Evaluation included clinical (e.g., suction intervention appropriateness), implementation (e.g., acceptability), and cost outcomes (implementation costs). Associations between implementation of the PAWS guideline and appropriateness of endotracheal suction intervention use were investigated using generalised linear models.

Results: Data from 439 eligible suctions were included in the analysis. Following PAWS implementation, inappropriate endotracheal tube intervention use reduced from 99% to 58%, an absolute reduction (AR) of 41% (95% confidence interval [CI]: 25%, 56%). Reductions were most notable for open suction systems (AR: 48%; 95% CI: 30%, 65%), 0.9% sodium chloride use (AR: 23%; 95% CI: 8%, 38%) and presuction and postsuction manual bagging (38%; 95% CI: 16%, 60%, and 86%; 95% CI: 73%, 99%), respectively. Clinicians perceived PAWS as acceptable and suitable for use.

Conclusions: Implementation of endotracheal tube suction appropriate use guidelines in a mixed paediatric intensive care unit was associated with a large reduction in inappropriate suction intervention use in paediatric patients with respiratory infections.

Keywords: Endotracheal suction; Implementation; Mechanical ventilation; Paediatric intensive care; Pediatrics; Respiratory infection.

MeSH terms

Child
Humans
Intubation, Intratracheal / adverse effects
Respiration, Artificial*
Respiratory Tract Infections*
Sodium Chloride
Suction / methods

Substances

Sodium Chloride