Super-mini PCNL (SMP) with suction versus standard PCNL for the management of renal calculi of 1.5 cm-3 cm: a randomized controlled study from a university teaching hospital.

PURPOSE: To assess the safety and efficacy of super-mini PCNL (SMP, 14 Fr) when compared to standard PCNL (sPCNL, 24-30 Fr) in the management of renal calculi of size ranging from 1.5 to 3 cm. METHODS: From February 2021 to January 2022, a total of 100 patients were randomized to either SMP group or sPCNL group in a 1:1 ratio (50 in each group) using computer-generated simple randomization. Demographic data, stone characteristics, operative times, perioperative complications, blood transfusions, postoperative drop in haemoglobin, postoperative pain, duration of hospital stay and stone-free rates were compared between the two groups. RESULTS: Mean stone volume (2.41 cm2 vs 2.61 cm2) and stone-free rates (98% vs 94%, p = 0.14) were similar in both the SMP and sPCNL groups, respectively. The SMP group had significantly longer mean operative times (51.62 ± 10.17 min vs 35.6 ± 6.8 min, p = 0.03). Intraoperative calyceal injury (1/50 vs 7/50, p = 0.42) and mean postoperative drop in haemoglobin (0.8 ± 0.7 g/dl vs 1.2 ± 0.81, p = 0.21) were lower in the SMP group, but not statistically significant. SMP group showed significantly lower mean postoperative pain VAS scores (5.4 ± 0.7 vs 5.9 ± 0.9, p = 0.03) and mean duration of hospital stay (28.38 ± 3.6 h vs 39.84 ± 3.7 h, p = 0.0001). Complications up to Clavien grade 2 were comparable, with grade ≥ 3 complications higher in the standard group, but not statistically significant. CONCLUSION: Super-mini PCNL is equally effective as standard PCNL in treating renal calculi up to 3 cm, with significantly reduced postoperative pain and duration of hospital stay and lower risk of Clavien grade ≥ 3 complications, although with higher operative times.

Clinical experience and complications with limited pleural dissection combined with a novel, simplified technique for thoracic Redon-like drain in vertebral body tethering.

PURPOSE: To report on our experience with a simplified, suction-bottle-drain technique of thoracic drain (Redon-like) combined with fully thoracoscopic vertebral body tethering (VBT) and a limited pleural approach, with particular focus on the rate of pulmonary complications. METHODS: A retrospective study was performed on all consecutive patients who underwent VBT for adolescent idiopathic scoliosis. For all subjects, a 10G Redon drain, an active drain system consisting of a perforated tube and a suction bottle, was placed intrathoracically and tunneled under the skin. All drains were removed on the first postoperative day. Perioperative and postoperative data such as type of access, length of surgery, amount of fluid collection in the drain, and length of hospital stay were collected. The type and number of pulmonary complications occurring in the first 3 months after surgery, along with their symptoms and management, were recorded. RESULTS: One Hundred eighty-two patients were included in the analysis. The mean length of surgery was 97 min (75-120). The average fluid collection in the drain was 30 ml (5-50), the mean length of hospital stay was 3 days (2-4). During the observation period, pulmonary complications occurred in five patients (2%). Two patients presented an aseptic right pleural effusion; for two patients, a residual pneumothorax was diagnosed on the X-rays in the recovery room and one patient developed a chylothorax. All patients recovered without sequelae. CONCLUSION: The simplified, Redon-like drain combined with a fully thoracoscopic VBT and limited pleural approach seems a safe and effective alternative to the chest drain. This technique allows to remove the drain on the first postoperative day, thus simplifying the management of the patients and improving their comfort.

Effect of intraoperative abdominal lavage versus suction alone on postoperative wound infection in patients with appendicitis: A meta-analysis.

There is much controversy about the application of abdominal irrigation in the prevention of wound infection (WI) and intra-abdominal abscess (IAA) in the postoperative period. Therefore, we performed a meta-analysis of the effect of suctioning and lavage on appendectomy to assess the efficacy of either suctioning or lavage. Data were collected and estimated with RevMan 5.3 software. Based on our research, we found 563 publications in our database, and we eventually chose seven of them to analyse. The main results were IAA after the operation and WI. Inclusion criteria were clinical trials of an appendectomy with suctioning or lavage. In the end, seven trials were chosen to meet the eligibility criteria, and the majority were retrospective. The results of seven studies showed that there was no statistically significant difference between abdominal lavage and suctioning treatment for post-operative WI (OR, 1.82; 95% CI, 0.40, 2.61; p = 0.96); There was no statistically significant difference between the two groups in the risk of postoperative abdominal abscess after operation (OR, 1.16; 95% CI, 0.71, 1.89; p = 0.56). No evidence has been found that the use of abdominal lavage in the treatment of postoperative infectious complications after appendectomy is superior to aspiration.

Implementing paediatric appropriate use criteria for endotracheal suction to reduce complications in mechanically ventilated children with respiratory infections.

BACKGROUND: Endotracheal suction is used to maintain endotracheal tube patency. There is limited guidance to inform clinical practice for children with respiratory infections. OBJECTIVE: The objective of this study was to determine whether implementation of a paediatric endotracheal suction appropriate use guideline Paediatric AirWay Suction (PAWS) is associated with an increased use of appropriate and decreased use of inappropriate suction interventions. METHODS: A mixed-method, pre-implementation-post-implementation study was conducted between September 2021 and April 2022. Suction episodes in mechanically ventilated children with a respiratory infection were eligible. Using a structured approach, we implemented the PAWS guideline in a single paediatric intensive care unit. Evaluation included clinical (e.g., suction intervention appropriateness), implementation (e.g., acceptability), and cost outcomes (implementation costs). Associations between implementation of the PAWS guideline and appropriateness of endotracheal suction intervention use were investigated using generalised linear models. RESULTS: Data from 439 eligible suctions were included in the analysis. Following PAWS implementation, inappropriate endotracheal tube intervention use reduced from 99% to 58%, an absolute reduction (AR) of 41% (95% confidence interval [CI]: 25%, 56%). Reductions were most notable for open suction systems (AR: 48%; 95% CI: 30%, 65%), 0.9% sodium chloride use (AR: 23%; 95% CI: 8%, 38%) and presuction and postsuction manual bagging (38%; 95% CI: 16%, 60%, and 86%; 95% CI: 73%, 99%), respectively. Clinicians perceived PAWS as acceptable and suitable for use. CONCLUSIONS: Implementation of endotracheal tube suction appropriate use guidelines in a mixed paediatric intensive care unit was associated with a large reduction in inappropriate suction intervention use in paediatric patients with respiratory infections.

Is it feasible to avoid suction before spontaneous breathing is established?

BACKGROUND: Suctioning of the posterior pharynx immediately after birth during neonatal resuscitation can produce a vagal response resulting in bradycardia or apnea. The feasibility of delaying any airway suctioning and avoiding deep suctioning has not been studied. OBJECTIVES: To test the hypothesis that newborn resuscitation is feasible with the following two guidelines: 1) avoiding any suctioning until the infant establishes spontaneous respiration, and 2) avoiding the use of deep suction with catheters. STUDY DESIGN: A quality improvement project was implemented using these two guidelines. Infants' mouth was cleaned with a dry cloth. No suction was started until infants establish spontaneous breathing. Then, bulb suction was used to clear secretions from the sides of the mouth and the nose without reaching the back of the pharynx. Deep suction using catheters was not used. Neonatal staff and physicians received biweekly training to support these changes. Resuscitation data before and after the practice change were compared. RESULTS: A total of 999 sequential cases were compared; of them 501 and 498 infants were resuscitated before and after the implementation of the new practice, respectively. Suction before spontaneous breathing occurred in 12.4% in the first cohort. There were no differences between groups except for less use of oxygen with the new guidelines (12.4% vs 4.4%, P < 0.001). CONCLUSION: Avoidance of any suction prior to spontaneous breathing and not applying deep suction with catheters are feasible during newborn resuscitation. These practices are associated with decreased exposure to oxygen in the delivery room.

Percutaneous treatment of liver hydatid cysts: to PAIR or not to PAIR.

PURPOSE OF REVIEW: The aim is to review recent literature for percutaneous treatment of liver hydatid cysts (cystic echinococcosis: CE) via different techniques such as PAIR (puncture, aspiration, injection, and reaspiration), standard catheterization, and modified catheterization technique (MoCaT). RECENT FINDINGS: PAIR is an established technique and considered to be safe and effective for CE1 and CE3a as it is associated with lower morbidity, mortality, recurrence, and shorter hospital stay as compared with surgery. Standard catheterization is also dedicated for the treatment of CE1 and CE3a. PAIR should be preferred for treatment of liver CE1 and CE3a cysts, since PAIR is associated with lower major complication rates and shorter hospital stay. However, standard catheterization technique is indicated when cysto-biliary fistula develops or any technical difficulty arises during the PAIR. In these cases it is needed to switch PAIR to standard catheterization to complete the procedure. SUMMARY: For CE1 and CE3a cysts, PAIR and standard catheterization are the choice for percutaneous treatments, while MoCaT is a treatment option for CE2 and CE3b cysts.

Benefits and harms of gastric suction or lavage at birth for gastrointestinal outcomes: A systematic review and meta-analysis.

The benefits of routine gastric suctioning or lavage in neonates remain uncertain, despite the common practice worldwide. To investigate the potential advantages and harms, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the effects of these procedures in healthy or meconium-stained neonates at birth. We systematically searched PubMed, Scopus, Embase, Ovid, and the Cochrane Library databases from inception to February 9, 2023. We included only RCTs assessing the outcomes of gastric suction or lavage in neonates at birth. We calculated risk ratio (RR) and weighted mean differences with 95% confidence intervals (CIs) using a random-effects model. The primary outcomes were gastrointestinal symptoms including vomiting, retching, feeding intolerance, and secondary aspiration. The secondary outcomes included time to initiation of breastfeeding and potential adverse procedure-related events. Twelve RCTs with a total of 4,122 neonates were analyzed. All the studies compared neonates who received gastric suction or lavage with those who received usual care. Gastrointestinal symptoms were significantly reduced in neonates receiving gastric suction or gastric lavage compared with the control group (RR, 0.75; 95% CI, 0.63-0.89). Gastric lavage was beneficial for infants with meconium-stained amniotic fluid (RR 0.71; 95% CI, 0.60-0.84), while gastric suction had no significant benefit in reducing gastrointestinal symptoms in infants without meconium-stained amniotic fluid (RR 0.91; 95% CI, 0.61-1.37). Our findings suggest that gastric suction or lavage may reduce gastrointestinal symptoms in neonates; however, these procedures may only benefit infants born with meconium-stained amniotic fluid. Vigorous newborns without meconium-stained amniotic fluid may not benefit from these procedures. Furthermore, gastric suction may lead to adverse outcomes such as apnea and bradycardia. Registration: This study was registered in the PROSPERO International prospective register of systematic reviews in health and social care (CRD42023247780).

Evaluation of complications and long-term outcomes associated with 101 dogs and cats discharged with and without subcutaneous active closed-suction drains (2014-2022).

OBJECTIVE: To retrospectively evaluate complications reported in dogs and cats with a closed suction subcutaneous drain that were either managed completely in hospital (Group ND) or discharged home for ongoing outpatient care (Group D). ANIMALS: 101 client-owned animals involving 94 dogs and 7 cats with a subcutaneous closed suction drain placed during a surgical procedure. PROCEDURES: Electronic medical records (January 2014 to December 2022) were reviewed. Signalment, reason for drain placement, surgical procedure, location and duration of drain placement, drain discharge status, antimicrobial usage, culture and sensitivity results, and intraoperative and postoperative complications were recorded. Associations among variables were evaluated. RESULTS: There were 77 animals in Group D and 24 animals in Group ND. Majority (n = 21/26) of complications were classified as minor and were all from Group D. Length of hospitalization in Group D (1 day) was significantly shorter than Group ND (3.25 days). Duration of drain placement was significantly longer in Group D (5.6 days) than Group ND (3.1 days). There were no associations between drain location, drain duration, or surgical site contamination with risk of complications. CLINICAL RELEVANCE: There is a higher risk of complications associated with discharging an animal from hospital (37%) with a subcutaneous closed suction drain than removing it prior to discharge (4%). These complications, however, were primarily minor and easily managed. Discharging an otherwise stable animal to home with a subcutaneous closed suction drain may be feasible to decrease duration of hospitalization, cost to the owner, and stress for the animal.

Factors Affecting Postoperative Complications of Suction-Curettage by Arthroscopic Shaver for Bromhidrosis.

BACKGROUND: Suction-curettage by arthroscopic shaver is the most effective treatment for bromhidrosis; however, postoperative complications require wound management and exhibit a high risk of hypertrophic scarring. We investigated factors affecting postoperative complications. METHODS: We retrospectively evaluated data for 215 patients (430 axillae) with bromhidrosis treated with suction-curettage by arthroscopic shaver between 2011 and 2019. Cases followed for less than 1 year were excluded. Complications of hematoma or seroma, epidermis decortication, skin necrosis, and infection were recorded. Multinomial logistic analysis was used to calculate odds ratios and corresponding 95% confidence intervals for the complication of the surgery, adjusting for relevant statistically significant variables. RESULTS: Complications occurred in 52 axillae (12.1%). Epidermis decortication occurred in 24 axillae (5.6%), with a significant difference for age (P < 0.001). Hematoma occurred in 10 axillae (2.3%) with a significant difference in tumescent infiltration use (P = 0.039). Skin necrosis occurred in 16 axillae (3.7%) with a significant difference for age (P = 0.001). Infection occurred in 2 axillae (0.5%). Severe scarring occurred in 15 axillae (3.5%), with complications related to more severe skin scarring (P < 0.05). CONCLUSION: Older age was a risk factor for complications. Use of tumescent infiltration resulted in good postoperative pain control and less hematoma. Patients with complications presented with more severe skin scarring, but none experienced limited range of motion after massage.

The impact of suction addition to simple water seal on the outcomes after pulmonary surgery: A meta-analysis.

BACKGROUND: Chest tube drainage during pulmonary surgery is fundamental to removing air and fluid, as well as for lung re-expansion. However, the advantages of adding external suction to the water seal are under debate. OBJECTIVES: The aim of the study was to conduct a meta-analysis in order to assess the effects of adding suction to a simple water seal on the outcomes of lung surgery. MATERIAL AND METHODS: A search of the literature up to November 2021 found 14 studies with 2449 lung surgery patients. Of these patients, 1092 received suction drainage and 1357 received a simple water-seal drainage. The studies reported the effects of adding suction to a simple water seal on postoperative outcomes after lung surgery. A randomor fixed-effect model determined the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (95% CIs) to compare the outcomes. RESULTS: In patients undergoing lung surgery, suction resulted in a substantially longer chest tube duration (MD = 0.74, 95% CI: 0.90-1.40, p = 0.03, Z = 2.21) and a smaller postoperative pneumothorax (OR = 0.27, 95% CI: 0.13-0.59, p = 0.02, Z = 2.24) than a simple water seal. However, no differences existed in prolonged air leak (p = 0.91, Z = 0.12), air leak duration (p = 0.28, Z = 1.07) or length of hospital stay (p = 0.23, Z = 1.2) between the 2 approaches. CONCLUSION: Suction led to considerably longer chest tube duration and lower postoperative pneumothorax, but no significant difference in sustained air leak, air leak duration or length of hospital stay was observed compared to a simple water seal in patients undergoing pulmonary surgery. Further research is needed to validate these findings and increase confidence, particularly regarding the postoperative pneumothorax results.

First use of large-bore suction thrombectomy for acute pulmonary embolism in Asia-Pacific: feasibility and short-term clinical outcomes.

Clinical outcomes for intermediate or high-risk pulmonary emboli (PE) remain sub-optimal, with limited improvements in survival for the past 15 years. Anticoagulation alone results in slow thrombus resolution, persistent right ventricular (RV) dysfunction, patients remaining at risk of haemodynamic decompensation and increased likelihood of incomplete recovery. Thrombolysis elevates risk of major bleeding and is thus reserved for high-risk PE. Thus, a huge clinical need exists for an effective technique to restore pulmonary perfusion with minimal risk and avoidance of lytic therapy. In 2021, large bore suction thrombectomy (ST) was introduced in Asia for the first time and this study assessed the feasibility and short-term outcomes of Asian patients undergoing ST for acute PE. 40 consecutive patients (58% male, mean age of 58.3 ± 16.6 years) with intermediate (87.5%) or high-risk PE (12.5%) were enrolled in this prospective registry. 20% had prior VTE, 42.5% had contraindications to thrombolysis, and 10% failed to respond to thrombolysis. PE was idiopathic in 40%, associated with active cancer in 15% and post-operative status in 12.5%. Procedural time was 124 ± 30 min. Emboli were aspirated in all patients without the need for thrombolytics, resulting in a 21.4% reduction in mean pulmonary arterial pressures and 123% increase TASPE-PASP ratio, a prognostic measure of RV-arterial coupling. (both p < 0.001) Procedural complications were 5% and 87.5% patients survived to discharge without symptomatic VTE recurrence during 184 days of mean follow-up. ST affords an effective reperfusion option for PE without thrombolytics, normalises RV overload and provides excellent short-term clinical outcomes.

Reverse Suction Decompression Using the Superior Thyroid Artery During Clipping of a Complex Anterior Choroidal Artery Aneurysm.

Direct aneurysmal suction decompression was first described by Dr. Flamm in 1981 to improve safety and ease clipping of complex aneurysms by deflating their dome.1 This technique evolved over the following decade, from direct aneurysmal puncture to indirect-reverse-suction decompression (RSD).2,3 The conventional technique for RSD involves a cannulation of the internal (ICA) or common (CCA) carotid arteries.2-9 Direct puncture of either the CCA or ICA carry risk of arterial wall damage (e.g., dissection), which may result in significant morbidity.10,11 We routinely cannulate the superior thyroidal artery (SThA) as the vascular access to perform RSD. This subtle technical nuance prevents dissection of either the CCA or ICA while providing a reliable source for RSD.12 In this operative video, the SThA was cannulated to apply reverse suction decompression, which allowed releasing perforating arteries from the dome of an anterior choroidal artery aneurysm in a 68-year-old lady. The patient tolerated the procedure well, was discharged without neurologic deficits, and resumed normal life with no aneurysm remnant. The patient consented to the procedure and video/photography publication. RSD is an optimal technique to enhance efficiency and safety when dissecting around the dome of a complex intradural ICA aneurysm. The use of the SThA avoids the risk of ICA or CCA wall damage due to access, which defeats the protective purpose of RSD itself. Video 1 provides an educational example of the SThA cannulation technique for RSD during dissection and clipping of a complex anterior choroidal artery aneurysm.

Effect of optimizing the use of endoscope on the efficiency of microdynamic bromhidrosis removal operation.

BACKGROUND: Bromhidrosis, also known as body odor, is a common disease in life, which often occurs in young adults. The histological basis of bromhidrosis is the hyperplasia of apocrine sweat glands. OBJECTIVE: To compare the effects of different methods of endoscopy in microdynamic axillary osmidrosis removal on curative effect, complications, and surgical efficiency. METHODS: A total of 149 patients with axillary osmidrosis were treated in our hospital from January 2020 to December 2021. They were treated with endoscopic assistance in the whole process of operation (Group A) and endoscope-assisted exploration after blind rotary cutter suction (Group B), respectively, and the curative effect, complication rate, and surgical efficiency were evaluated. RESULTS: There was no significant difference in the curative effect and complication rate between the two groups, but the endoscope-assisted exploration group after suction with rotary cutter (Group B) had higher surgical efficiency. CONCLUSION: On the basis of professional use of rotary cutter, it is efficient to choose endoscope to check the excision of sweat gland in the operation area and stop bleeding in time after blind suction.

Modified Orbitozygomatic Craniotomy, Anterior Clinoidectomy, and Retrograde Suction Decompression "Dallas Technique" for Large Unruptured Clinoidal-Ophthalmic Segment Aneurysm.

Simple clip trapping may not adequately decompress giant paraclinoidal or ophthalmic artery aneurysms for safe permanent clipping.1-10 Full temporary interruption of the local circulation via clipping of the intracranial carotid artery with concomitant suction decompression via an angiocatheter placed in the cervical internal carotid artery as originally described by Batjer et al3 allows the primary surgeon to use both hands to clip the target aneurysm. Detailed understanding of skull base and distal dural ring anatomy is critical for microsurgical clipping of giant paraclinoid and ophthalmic artery aneurysms.2-4 Microsurgical approaches allow for direct decompression of the optic apparatus as opposed to endovascular coiling or flow diversion that may contribute to increased mass effect.11 We describe the case of a 60-year-old woman who presented with left-sided visual loss, a family history of aneurysmal subarachnoid hemorrhage, and a giant unruptured clinoidal-ophthalmic segment aneurysm with both extradural and intradural components.2 The patient underwent an orbitopterional craniotomy, Hakuba "peeling" of the temporal dura propria from the lateral wall of the cavernous sinus, and anterior clinoidectomy (Video 1). The proximal sylvian fissure was split, the distal dural ring was completely dissected, and the optic canal and falciform ligament were opened. The aneurysm was trapped, and retrograde suction decompression via the "Dallas Technique" was employed for safe clip reconstruction of the aneurysm.3,4 Postoperative imaging showed complete obliteration of the aneurysm, and the patient remained at her neurologic baseline. The technical considerations and literature regarding the suction decompression technique to treat giant paraclinoid aneurysms are reviewed.2-4 The patient and family provided informed consent for the procedure and consented to the publication of her images.

How I do it: The microsurgical clipping of the giant paraclinoid aneurysm using the retrograde suction decompression technique.

BACKGROUND: Paraclinoid aneurysms account for 5.4% of all intracranial aneurysms. Giant aneurysms are found in 49% of these cases. The 5-year cumulative rupture risk is 40%. Microsurgical treatment of paraclinoid aneurysms is a complex challenge that requires a personalized approach. METHOD: Extradural anterior clinoidectomy and optic canal unroofing were performed in addition to orbitopterional craniotomy. Falciform ligament and distal dural ring transection provided the internal carotid artery and optic nerve mobilization. Retrograde suction decompression was used to soften the aneurysm. Clip reconstruction was performed using tandem angled fenestration and parallel clipping techniques. CONCLUSION: Orbitopterional approach with extradural anterior clinoidectomy combined with retrograde suction decompression technique is a safe and effective modality for treatment of giant paraclinoid aneurysms.

Saline irrigation versus gauze wiping and suction only for peritoneal decontamination during laparoscopic repair for perforated peptic ulcer disease.

The aim of current single-center study was to compare the short-term outcome of suction and gauze wiping alone versus the irrigation and suction technique for peritoneal decontamination among patients who underwent laparoscopic repair of PPU. Using data from our institution's prospectively maintained database, 105 patients who underwent laparoscopic repair were enrolled in this study. The participants were further divided into the group who received peritoneal irrigation (irrigation group, n = 67) and group who received gauze wiping and suction only (suction only group, n = 38). The irrigation group had a longer operative time (140 vs. 113 min, p = 0.0001), higher number of drainage tubes (38.8% vs. 0%, p < 0.0001) and a higher incidence of intra-abdominal abscess (10.4% vs. 0%, p = 0.0469) than the suction only group. Peritoneal irrigation may be associated with a prolonged operative time and a higher number of abdominal drains. Meanwhile, gauze wiping and suction may be sufficient for peritoneal decontamination during the laparoscopic repair of PPU as further infectious complications are not observed.

Comparative diagnostic performance of different techniques for EUS-guided fine-needle biopsy sampling of solid pancreatic masses: a network meta-analysis.

BACKGROUND AND AIMS: Evidence is limited on the comparative diagnostic performance of tissue sampling techniques for EUS-guided fine-needle biopsy sampling of pancreatic masses. We performed a systematic review with network meta-analysis to compare these techniques. METHODS: Rates of sample adequacy, blood contamination, and tissue integrity using fine-needle biopsy sampling needles were evaluated. Direct and indirect comparisons were performed among the slow-pull, dry-suction, modified wet-suction, or no-suction techniques. Results are expressed as risk ratio (RR) and 95% confidence interval (CI). RESULTS: Overall, 9 randomized controlled trials (756 patients) were identified. On network meta-analysis, the no-suction technique was significantly inferior to the other techniques (RR, .85 [95% CI, .78-.92] vs slow pull; RR, .85 [95% CI, .78-.92] vs dry suction; RR, .83 [95% CI, .76-.90] vs modified wet suction) in terms of sample adequacy. Consequently, modified wet suction was shown to be the best technique (surface under the cumulative ranking curve score, .90), with the no-suction technique showing poorer performance in terms of sample adequacy (surface under the cumulative ranking curve score, .14). Dry suction was associated with significantly higher rates of blood contamination as compared with the slow-pull technique (RR, 1.44; 95% CI, 1.15-1.80), whereas no suction led to less blood contamination of samples in comparison with other techniques (RR, .71 [95% CI, .52-.97] vs slow pull; RR, .49 [95% CI, .36-.66] vs dry suction; RR, .57 [95% CI, .40-.81] vs modified wet suction). The modified wet-suction technique significantly outperformed dry suction in terms of tissue integrity of the sample (RR, 1.36; 95% CI, 1.06-1.75). CONCLUSIONS: Modified wet suction seemed to provide high rates of integrity and adequate samples, albeit with high blood contamination. The no-suction technique performed significantly worse than other sampling strategies.

Efficacy and safety of non-pharmacological interventions for endotracheal suctioning pain in preterm infants: A systematic review.

AIM: To review and analyse the evidence on the efficacy and safety of non-pharmacological interventions for preterm infants to relieve endotracheal suctioning (ES) pain. DESIGN: A systematic review per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS: Six databases were searched with a retrieval strategy. Parallel and crossover randomized controlled trials reporting non-pharmacological interventions for relieving ES pain in preterm infants were identified from inception to 1 September 2021. The protocol was published in PROSPERO (CRD42021276058). RESULTS: Ten studies were retrieved, including nine different non-pharmacological interventions. Seven studies reported that non-pharmacological interventions in relieving pain were more effective than conventional care during ES, and three trials reported its safety. Due to the heterogeneity of pain assessment tools, time of assessment and population, only Facilitated tucking had sufficient evidence that it is a safe and effective non-pharmacological intervention.