以质量求发展，以服务铸品牌

护理学报 ›› 2022, Vol. 29 ›› Issue (24): 38-42.doi: 10.16460/j.issn1008-9969.2022.24.038

• 循证护理 • 上一篇    下一篇

新生儿机械通气患者气道内吸引的最佳证据总结

唐帆1, 李亚玲1,2a, 罗曼月1, 王兆北2b, 黎张双子2c, 蔡鹏2a   

  1. 1.贵州医科大学 护理学院,贵州 贵阳 550025;
    2.贵州医科大学附属医院 a.护理部; b.肝胆外科;c.重症医学科,贵州 贵阳 550004
  • 收稿日期:2022-07-14 出版日期:2022-12-25 发布日期:2023-01-13
  • 通讯作者: 李亚玲（1965-）,女,贵州贵阳人,本科学历,主任护师,护理部主任,硕士研究生导师。E-mail：liyaling0118@126.com
  • 作者简介:唐帆（1995-）,女,贵州毕节人,本科学历,硕士研究生在读,护师。
  • 基金资助:
    贵州省临床重点专科培育项目（SZD-PY-2017-04）; 贵州医科大学护理学科教学与科学研究专项课题（YJ20061）

Best Evidence Summary for Endotracheal Suctioning in Neonates with Mechanical Ventilation

TANG Fan1, LI Ya-ling1,2a, LUO Man-yue1, WANG Zhao-bei2b, LI Zhang-shuangzi2c, CAI Peng2a   

  1. 1. School of Nursing, Guizhou Medical University, Guiyang 550025, China;
    2a. Dept. of Nursing Administration; 2b. Dept. of Hepatobiliary Surgery; 2c. Dept. of Critical Care Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang 550004,China
  • Received:2022-07-14 Online:2022-12-25 Published:2023-01-13

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摘要： 目的 整合及评价机械通气新生儿气道内吸引的证据,为临床提供循证依据。方法 检索UpToDate、BMJ、Cochrane Library、JBI、NGC、NICE、RNAO、CINAHL、PubMed、EMbase、Scopus、万方、中国知网、美国呼吸治疗协会及欧洲呼吸学会官方网站。由2名经过专业循证培训的评价员独立进行质量评价并结合专家意见形成证据总结。结果 共纳入11篇文献,包括指南4篇、推荐实践1篇、证据总结2篇、系统评价4篇,共汇总了吸引指征、吸引准备、吸引实施、吸引整理及非常规性操作5个维度共20条最佳证据。结论 本研究为临床医护人员进行新生儿气道内吸引规范化操作提供了循证依据,旨在提升新生儿气道管理水平和护理质量。

关键词: 新生儿, 机械通气, 气道内吸引, 证据总结

Abstract: Objective To extract, integrate and evaluate evidence of endotracheal suctioning in newnates with mechanical ventilation, and provide evidence-based reference for clinical neonatal airway management. Methods We retrieved literature in databases including UpToDate, BMJ, Cochrane Library, JBI, NGC, NICE, RNAO, CINAHL, PubMed, Embase, Scopus, Wanfang Data, CNKI, the official website of American Association for Respiratory Care and European Respiratory Society. Quality evaluation of eligible literature was conducted by two researchers with evidence-based training independently and evidence summary was performed combined with the opinions of experts. Results Eleven articles were collected, including 4 guidelines, 1 recommended practice, 2 evidence summaries and 4 systematic evaluations. A total of 20 pieces of best evidence were summarized in 5 dimensions, including suction indication, suction preparation, suction implementation, suction disposition and unconventional operation. Conclusion The study provides evidence-based reference for standardized neonatal endotracheal suctioning, thus to improve neonatal airway management and nursing quality.

Key words: neonates, mechanical ventilation, endotracheal suctioning, evidence summary

中图分类号: 

  • R473.72
[1] Morrow BM.Airway Clearance Therapy in Acute Paediatric Respiratory Illness: A State-of-the-art Review[J]. S Afr J Physiother,2019,75(1):1295. DOI:10.4102/sajp.v75i1.1295.
[2] Coutinho WM, Vieira PJC, Kutchak FM, et al.Comparison of Mechanical Insufflation-exsufflation and Endotracheal Suctioning in Mechanically Ventilated Patients: Effects on Respiratory Mechanics, Hemodynamics, and Volume of Secretions[J]. Indian J Crit Care Med, 2018,22(7):485-490. DOI:10.4103/ijccm.IJCCM_164_18.
[3] Silva ARAD, Silva TCD, Bom GJT, et al.Ventilator-associated Pneumonia Agents in Brazilian Neonatal Intensive Care Units - a Systematic Review[J]. Braz J Infect Dis,2018,22(4):338-344. DOI:10.1016/j.bjid.2018.06.002.
[4] Schults JA, Long DA, Mitchell ML, et al.Adverse Events and Practice Variability Associated with Paediatric Endotracheal Suction: An Observational Study[J]. Aust Crit Care, 2020,33(4):350-357. DOI:10.1016/j.aucc.2019.08.002.
[5] 魏征,吴佳铭,叶文成,等.ICU护士气道管理现状及循证实践态度调查[J].中国护理管理, 2015,15(5):563-566.DOI:10.3969/j.issn.1672-1756.2015.05.015.
[6] 胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018.
[7] Brouwers MC, Kho ME, Browman GP, et al.AGREE II: Advancing Guideline Development, Reporting, and Evaluation in Health Care[J].Prev Med,2010,51(5):421-424. DOI:10.1016/j.ypmed.2010.08.005.
[8] The Joanna Briggs Institute. Critical Appraisal Check Listfor Textand Opinion(JBI)[EB/OL].(2017-11-24)[2022-01-18].http://joannabriggs.org/research/critical-appraisal-tools.html.
[9] 王春青,胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[10] Blakeman TC, Scott JB, Yoder MA, et al.AARC Clinical Practice Guidelines: Artificial Airway Suctioning[J]. Respir Care,2022,67(2):258-271. DOI:10.4187/respcare.09548.
[11] 中国医师协会新生儿科医师分会循证专业委员会,中国医师协会新生儿科医师分会呼吸专业委员会.2020新生儿机械通气时气道内吸引操作指南[J].中国当代儿科杂志, 2020, 22(6):533-542.DOI:10.7499/j.issn.1008-8830.2004168.
[12] National Guideline Clearinghouse(NGC). Daily Care Processes Guide for Reducing Ventilator-Associated Events in Mechanically Ventilated Patients[EB/OL].(2017-01-30)[2022-01-25].https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/daily-care-processes-guide.pdf.
[13] Tu CF, Kao HM, Chang YJ.Development of Evidence-based Clinical Practice Guidelines for Endotracheal Suction in Premature Infants[J].Hu li za zhi,2014,61(1):42-53.DOI:10.6224/JN.61.1.42.
[14] Munn Z, Lockwood C, Moola S.Endotracheal Suctionong:Practice Considerations [EB/OL]. (2021-05-05)[2022-01-18].http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=jbi&NEWS=N&AN=JBI1866.
[15] Moola S. Evidence Summary.Endotracheal Suctioning: Frequency and Duration. [EB/OL]. (2021-10-10)[2022-01-18]. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=jbi&NEWS=N&AN=JBI231.
[16] Porritt K. Evidence Summary. Suctioning (Endotracheal or Tracheostomy):Installation of Normal Saline [EB/OL].(2021-04-27)[2022-01-18].http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=jbi&NEWS=N&AN=JBI23595.
[17] Schults JA, Mitchell ML, Cooke M, et al.Endotracheal Suction Interventions in Mechanically Ventilated Children: An Integrative Review to Inform Evidence-based Practice[J].Aust Crit Care,2021,34(1):92-102. DOI:10.1016/j.aucc.2020.05.003.
[18] Bruschettini M, Zappettini S, Moja L, et al. Frequency of Endotracheal Suctioning for the Prevention of Respiratory Morbidity in Ventilated Newborns[J]. Cochrane Database Syst Rev,2016, 3:CD011493.DOI:10.1002/14651858.CD011493.pub2.
[19] Pinto HJ, D'silva F, Sanil TS.Knowledge and Practices of Endotracheal Suctioning amongst Nursing Professionals: A Systematic Review[J]. Indian J Crit Care Med,2020,24(1):23-32. DOI:10.5005/jp-journals-10071-23326.
[20] Fisk AC.The Effects of Endotracheal Suctioning in the Pediatric Population: An Integrative Review[J].Dimens Crit Care Nurs,2018,37(1):44-56.DOI:10.1097/DCC.0000000000000275.
[21] Shamali M, Abbasinia M, Østergaard B, et al.Effect of Minimally Invasive Endotracheal Tube Suctioning onPhysiological Indices in Adult Intubated Patients: An Open-labelled Randomised Controlled Trial[J].Aust Crit Care, 2019,32(3):199-204. DOI:10.1016/j.aucc.2018.03.007.
[22] 吕云霞,冯少娟,刘正伟,等.气管切开术后非机械通气患儿早期气道并发症预防的最佳证据总结[J].护理学报,2021,28(13):46-51.DOI:10.16460/j.issn1008-9969.2021.13.046.
[23] Javadi M, Hejr H, Zolad M, et al.Comparing the Effect of Endotracheal Tube Suction Using Open Method with Two Different Size Catheters 12 and 14 on Discharge Secretion, Pain, Heart Rate, Blood Pressure, and Arterial Oxygen Saturation of Patients in the Intensive Care Unit: A Randomized Clinical Trial[J]. Annals of TropicalMedicine and Public Health,2017,10(5):1312-1317.DOI:10.4103/ATMPH.ATMPH18117.
[24] Scott JB, Dubosky MN, Vines DL, et al.Evaluation of Endotracheal Tube Scraping on Airway Resistance[J]. Respir Care.2017,62(11):1423-1427. DOI:10.4187/respcare.05391.
[25] Ebrahimian A, Tourdeh M, Paknazar F, et al.The Effect of the Open and Closed System Suctions on Pain Severity and Physiological Indicators in Mechanically Ventilated Patients with Traumatic Brain Injury: A Randomised Controlled Trial[J].Turk J Anaesthesiol Reanim, 2020, 48(3):202-207. DOI:10.5152/TJAR.2019.03342.
[26] Santa Cruz R, Villarejo F, Irrazabal C, et al. High Versus Low Positive End-expiratory Pressure (PEEP) Levels for Mechanically Ventilated Adult Patients with Acute Lung Injury and Acute Respiratory Distress Syndrome[J]. Cochrane Database Syst Rev, 2021,3(3):CD009098.DOI:10.1002/14651858.
[27] Gomes Neto M, da Silva Lopes IA, et al. The Effect of Facilitated Tucking Position During Painful Procedure in Pain Management of Preterm iInfants in Neonatal Intensive Care Unit: A Systematic Review and Meta-analysis[J].Eur J Pediatr,2020,179(5):699-709.DOI:10.1007/s00431-020-03640-5.
[28] 吴益玲,陈晓春.新生儿重症监护病房人工气道管理床边交接表的设计及应用[J].护理学报,2017,24(15):75-78.DOI:10.16460/j.issn1008-9969.2017.15.075.
[29] Siegel JD, Rhinehart E, Jackson M, et al.2007Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings[J]. Am J Infect Control,2007, 35(10 Suppl 2):S65-S164.DOI:10.1016/j.ajic.2007.10.007.
[30] Cabrini L, Landoni G, Baiardo Redaelli M, et al.Tracheal Intubation in Critically Ill Patients: A Comprehensive Systematic Review of Randomized Trials[J].Crit Care,2018,22(1):1-9. DOI:10.1186/s13054-017-1927-3.
[31] Qiao Z, Yu J, Yu K, et al.The Benefit of Daily Sputum Suction Via Bronchoscopy in Patients of Chronic Obstructive Pulmonary Disease with Ventilators: A Randomized Controlled Trial[J]. Medicine (Baltimore), 2018,97(31):e11631. DOI:10.1097/MD.0000000000011631.
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