Adverse events and practice variability associated with pediatric endotracheal suction: An observational study

Abstract

AIMS & OBJECTIVES: 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 was to describe ETT suction practices in an Australian paediatric intensive care unit (PICU). METHODS: A prospective, observational study was undertaken in a 36-bed PICU. Children were eligible for inclusion if they were intubated and mechanically ventilated. Data on patient and suction variables (e.g. indication for ETT suction, normal saline instillation (NSI)) including potential predictive variables (age, severity of illness, NSI, hyperoxygenation) were collected. The main outcome variable was a composite measure of any AE. RESULTS: In total 955 suction episodes were recorded in 100 children. AEs occurred in 211 (22%) ETT suctions and were not associated with age, diagnostic category or 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 (OR 0.59; 95%CI 0.37-0.95; p= 0.028). Multivariable modelling revealed NSI was significantly associated with 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%CI1.74-4.37; p<0.001). Pre- suction increases in fraction of inspired oxygen (FiO2) were associated with an increased risk of AE (aOR 2.0; 95%CI1.27-3.15; p = 0.003). CONCLUSIONS: Prospective trial data are needed to determine the efficacy of suction interventions such as NSI. Improved evidence can inform evidence based guidelines which reduce variations in care and suction related AEs.L6347732112021-04-21 <br />