Brenda M. Morrow and Andrew C. Argent
One hundred eighteen English language articles, published between 1962 and June 2007 were included for final review. Owing to the paucity of objective pediatric data, all reports dealing with this topic were examined, including adult and neonatal studies. Despite the widespread use of endotracheal suctioning, very little high-level evidence dealing with paediatric endotracheal suctioning exists. The main findings of the review were that: no clear evidence that endotracheal suctioning improves respiratory mechanics, with most studies pointing to the detrimental effect it has on lung mechanics; suctioning should be performed when obstructive secretions are present rather than routinely; there is no clear evidence for the superiority of closed- or open-system suctioning, nor is there clear evidence for appropriate vacuum pressures and suction catheter size; sterility does not seem to be necessary when suctioning; preoxygenation has short-term benefits, but the longer-term impact is unknown; routine saline instillation before suctioning should not be performed and; recruitment maneuvers performed after suctioning have not been shown to be useful as standard practice.
Pediatric Critical Care Medicine 2008; 9(5):465 – 477