Who makes the decision?: A qualitative exploration of PICU nurses use of lung recruitment strategies following endotracheal suction

Abstract

Aims & Objectives: Endotracheal (ETT) suction is one of the most common airway interventions performed in the paediatric intensive care unit (PICU). During ETT suction the application of negative pressure to aspirate respiratory secretions leads to pulmonary derecruitment. Lung recruitment applied post suction can recruit collapsed alveoli, improve oxygenation and enhance gas exchange. Little is known about nurses' decision making regarding the application of lung recruitment strategies following ETT suction, however these decisions have a direct impact on patient outcomes and the occurrence of the post suction hypoxemic event. The objective of the study was to explore and describe the use of lung recruitment strategies with paediatric ETT suction in a cohort of Australian nurses. Methods Semi-structured interviews were conducted with 12 nurses from a tertiary referral PICU. An evidence-based practice model formed the conceptual basis for the study. Audiotaped interviews were transcribed. Inductive thematic analysis was used to code and analyse the interview data and identify themes. Results Three main themes were identified: patient's clinical presentation, clinician judgement and unit practice norms. Conclusions Variability in PICU nurses ETT suction practice was marked. Participants reported uncertainty regarding lung recruitment best practice. In general the application of lung recruitment strategies post ETT suction was perceived to be a physician responsibility, not a nursing responsibility. Nurses perceived the lack of research evidence as a barrier to making informed clinical decisions at the bedside. Rigorous research evaluating the safety and efficacy of LR following ETT suction is urgently required to inform best practice and decision making at the bedside.L6238159922018-09-13 <br />