• Dianne F McKinley, Sharon B Kinney, Beverley Copnell, and Frank Shann.
• Dianne F. McKinley is a clinical nurse, Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia. Sharon B. Kinney is a nurse consultant, Department of Nursing Research, Royal Children's Hospital; and a senior lecturer, Departments of Nursing and Pediatrics, The University of Melbourne, Victoria. Beverley Copnell is an associate professor, School of Nursing and Midwifery, La Trobe University, Victoria. Frank Shann is a medical doctor, Intensive Care Unit, Royal Children's Hospital. di.mckinley@rch.org.au.
• Am. J. Crit. Care. 2018 Nov 1; 27 (6): 486-494.

BackgroundSaline instillation is still used to assist in removal of secretions from endotracheal tubes in some pediatric intensive care units.ObjectiveTo compare the effect of using either no saline, quarter-normal (0.225%) saline, or normal (0.9%) saline during endotracheal suctioning of children receiving ventilatory support in a pediatric intensive care unit.MethodAn unblinded, randomized trial with 3 treatment groups was conducted with 427 children who received ventilatory support for at least 12 hours. Children were randomly assigned to receive no saline, 0.225% saline, or 0.9% saline during routine endotracheal suctioning.ResultsThe primary outcome was the number of hours of invasive mechanical ventilation; oxygen therapy and length of stay in the unit were secondary outcomes. There were 138 children randomly assigned to the no-saline group, 141 to the 0.225% saline group, and 148 to the 0.9% saline group. In Kaplan-Meier intention-to-treat analysis, the median (interquartile range) number of hours of invasive mechanical ventilation was 32 (20-68), 43 (21-86), and 40 (20-87) in the no-saline, 0.225% saline, and 0.9% saline groups, respectively. Although the no-saline group received fewer hours of invasive ventilation, oxygen therapy, and intensive care than the other groups combined, the differences were not statistically significant.ConclusionUsing no saline was at least as effective as using either 0.225% or 0.9% saline in endotracheal suctioning. The optimal policy may be to routinely use no saline with endotracheal suctioning in children but allow the occasional use of 0.9% saline when secretions are thick.©2018 American Association of Critical-Care Nurses.

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