To Suction or Not To Suction That is the question. Studies of endotracheal suction in post-operative cardiac patients

Abstract

Background Globally, cardiovascular disease is the leading cause of death with an estimated 17.9 million deaths worldwide. Cardiac surgery is widely performed, with post-operative care often including admission to an intensive care unit and a period of planned mechanical ventilation. Airway management includes endotracheal suction, which is known to have deleterious effects. This body of work investigates endotracheal suction in uncomplicated cardiac surgical patients. Aim The overarching aim of this thesis was to assess the safety of actively avoiding endotracheal suction in post-operative cardiac surgical patients ventilated for less than 12 hours. Additional aims included reviewing what evidence was available about avoidance of endotracheal suction in the adult intensive care unit patient population; describe local endotracheal suction practice, and elucidate the patient experience of the endotracheal tube and endotracheal suction. Methods included: • A systematic review investigating the evidence for the avoidance of endotracheal suction in the adult intensive care population. • An observational audit describing endotracheal suction practice within the cardiothoracic and vascular intensive care unit in Auckland City Hospital. • A point prevalence observational study describing suction practice across intensive care units in New Zealand and Australia. • A qualitative study to elucidate the patient experience of the endotracheal tube and endotracheal suction. • A prospective, non-inferiority, randomised controlled trial investigating the safety of avoiding endotracheal suction. Results The systematic review showed an absence of evidence regarding the avoidance of endotracheal suction. Both the observational and studies identified discrepancies between clinical guideline recommendations and clinical practice. The qualitative study found that half the participants recalled the endotracheal tube, although none recalled suction. Participants provided descriptions about emerging from the fog of sedation, hallucinations and early post-operative recovery. The randomised controlled trial demonstrated that endotracheal suction could safely be avoided in a patient cohort having cardiac surgery, with no increase in complications of extubation or escalation of oxygen therapy. Conclusions This body of work adds to the evidence about endotracheal suction; provides the first evidence about avoidance of endotracheal suction; describes the patient experience of the endotracheal tube and early post-operative recovery. These findings can be used to inform clinical practice and nurse education and training.