PMID- 31748181 OWN - NLM STAT- MEDLINE DCOM- 20210716 LR - 20210716 IS - 1036-7314 (Print) IS - 1036-7314 (Linking) VI - 33 IP - 4 DP - 2020 Jul TI - Adverse events and practice variability associated with paediatric endotracheal suction: An observational study. PG - 350-357 LID - S1036-7314(19)30099-2 [pii] LID - 10.1016/j.aucc.2019.08.002 [doi] AB - OBJECTIVE: The objective of this study was to determine the incidence of endotracheal tube (ETT) suction-related adverse events (AEs) and to examine associations between AEs and patient and suction characteristics. Secondary objectives were to describe ETT suction practices in an Australian paediatric intensive care unit (PICU). METHODS: A prospective, observational study was undertaken in a mixed cardiac and general PICU. Children were eligible for inclusion if they were intubated and mechanically ventilated. Data on patient and suction variables (indication for ETT suction, number of suction episodes per mechanical ventilation episode, indication for normal saline instillation [NSI] and NSI dose) including potential predictive variables (age, Paediatric Index of Mortality 3 [PIM3], NSI, positive end-expiratory pressure, and hyperoxygenation) were collected. The main outcome variable was a composite measure of any AE. MAIN RESULTS: A total of 955 suction episodes were recorded in 100 children. AEs occurred in 211 (22%) ETT suctions. Suction-related AEs were not associated with age, diagnostic category, or index of mortality score. Desaturation was the most common AE (180 suctions; 19%), with 69% of desaturation events requiring clinician intervention. Univariate logistic regression showed the odds of desaturation decreased as the internal diameter of the ETT increased (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.37-0.95; p = 0.028). Multivariable modelling revealed NSI was significantly associated with an increased risk of desaturation (adjusted OR [aOR]: 3.23; 95% CI: 1.99-5.40; p < 0.001) and the occurrence of an AE (aOR: 2.76; 95% CI: 1.74-4.37; p < 0.001). Presuction increases in fraction of inspired oxygen (FiO(2)) was significantly associated with an increased risk of experiencing an AE (aOR: 2.0; 95% CI: 1.27-3.15; p = 0.003). CONCLUSIONS: ETT suction-related AEs are common and associated with NSI and the requirement for pre-suction increases in FiO(2). Clinical trial data are needed to identify high-risk patient groups and to develop interventions which optimise practice and reduce the occurrence of ETT suction-related AEs. CI - Copyright (c) 2019 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved. FAU - Schults, Jessica A AU - Schults JA AD - Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia. Electronic address: j.schults@griffith.edu.au. FAU - Long, Debbie A AU - Long DA AD - Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Queensland, Australia. FAU - Mitchell, Marion L AU - Mitchell ML AD - Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia. FAU - Cooke, Marie AU - Cooke M AD - Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia. FAU - Gibbons, Kristen AU - Gibbons K AD - Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia. FAU - Pearson, Kylie AU - Pearson K AD - Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Queensland, Australia. FAU - Schibler, Andreas AU - Schibler A AD - Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Queensland, Australia; School of Medicine, The University of Queensland, Queensland, Australia. LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20191118 PL - Australia TA - Aust Crit Care JT - Australian critical care : official journal of the Confederation of Australian Critical Care Nurses JID - 9207852 MH - Adolescent MH - Child MH - Child, Preschool MH - Female MH - Humans MH - Infant MH - Infant, Newborn MH - Intensive Care Units, Pediatric/*organization & administration MH - Intubation, Intratracheal/*adverse effects/standards MH - Male MH - Organizational Policy MH - Prospective Studies MH - Suction/*adverse effects/standards OTO - NOTNLM OT - Adverse events OT - Clinical audit OT - Endotracheal suction OT - Intensive care OT - Normal saline OT - Paediatric EDAT- 2019/11/22 06:00 MHDA- 2021/07/17 06:00 CRDT- 2019/11/22 06:00 PHST- 2019/04/03 00:00 [received] PHST- 2019/08/12 00:00 [revised] PHST- 2019/08/20 00:00 [accepted] PHST- 2019/11/22 06:00 [pubmed] PHST- 2021/07/17 06:00 [medline] PHST- 2019/11/22 06:00 [entrez] AID - S1036-7314(19)30099-2 [pii] AID - 10.1016/j.aucc.2019.08.002 [doi] PST - ppublish SO - Aust Crit Care. 2020 Jul;33(4):350-357. doi: 10.1016/j.aucc.2019.08.002. Epub 2019 Nov 18.