Frequency of suctioning inside the tube that is used to ventilate newborn babies

Bruschettini et al, 6 March 2016, Cochrane review

Review question: We reviewed the evidence about the effects of different strategies in the frequency of suctioning of newborn babies that are on ventilators. Our main interest was prevention of lung damage.

Background: Newborns might need help with breathing as their lungs are still maturing. Anairway catheter (tube) is inserted into the mouth or nose in order to maintain an open airway (patency) in newborns who are unable to breathe on their own. This procedure is called endotracheal intubation. Endotracheal tube suction is necessary to clear secretions and to maintain airway patency, therefore ensuring that the baby receives enough oxygen. The goal of endotracheal intubation suction should be remove as much of the secretions as possible with minimal side effects associated with the procedure. However, suctioning causes stress, pain, and inflammation (swelling) of the windpipe in newborns. The optimal frequency of suctioning has not been defined. Suctioning inside the airway tube might be performed ‘as scheduled’ by the specialist or only ‘as needed’. Moreover, the ‘as scheduled’ approach might be more or less frequent. We explored the current evidence, up to October 2015, supporting one schedule or another.

Key results: There were no important differences on the time the babies were on the ventilator, occurrence of pneumothorax (collapsed lung), need for ventilation or oxygen at more than 30 days, bleeding in the brain, and death in the first month of life. In addition, the study reported no side effects.

Authors’ conclusions: There was insufficient evidence to identify the ideal frequency of ETT suctioning in ventilated neonates. Future research should focus on the effects in the very preterm newborns, that is, the most vulnerable population as concerns the risk of both lung and brain damage. Assessment should include the cases of prolonged ventilation, when more abundant, dense secretions are common. Clinical trials might include comparisons between ‘as-scheduled’ versus ‘as-needed’ endotracheal suctioning, that is, based on specific indications, as well frequent versus less frequent suctioning schedule