The efficacy of minitracheostomy for the management of sputum retention: a systematic review.

BACKGROUND: Suction via a minitracheostomy is a safe procedure, but its efficacy in facilitating sputum clearance in individuals with an acute condition has not been systematically reviewed. OBJECTIVES: The aim of this study was to identify and synthesise the efficacy of the insertion of a minitracheostomy and tracheal suction via minitracheostomy for sputum clearance in adults who have undergone surgery or have an acute condition characterised by sputum retention. DATA SOURCES: A systematic literature search using the electronic databases MEDLINE, CINAHL, EMBASE, Cochrane Library and PEDro, with searches limited to English language journal articles published between 1984 and September 2011. DATA EXTRACTION AND DATA SYNTHESIS: All study designs were included. Two independent reviewers used pre-defined inclusion and exclusion criteria to identify all eligible articles. RESULTS: Six studies in six patient groups met the inclusion criteria, with two randomised controlled trials and four case series included. These studies presented the results of 278 patients following surgery and 13 with acute medical conditions. There were a range of criteria that defined the efficacy of minitracheostomy for sputum retention. Studies reporting the adjunctive role found a reduced incidence of complications associated with sputum retention following thoracic surgery. Other studies reported limited benefit in overall respiratory status with minitracheostomy. Heterogeneity among the studies was evident, with major limitations identified. CONCLUSIONS: Limited evidence suggests that minitracheostomy may be a useful adjunct in optimising sputum clearance in adults following thoracic surgery, but the effects in adults with an acute condition and other types of surgery are inconclusive.

Construction of determination criteria of sputum retention in elderly patients with non-artificial airway / 中华护理杂志

Objective To establish criteria for determination of sputum retention in elderly patients with non-ar-tificial airway. Methods Interview and Delphi methods were used to preliminarily determine clinical indication of sputum retentionand its classification through two-round expert consultation among 25 experts. Final criteria for de-termination of sputum retention were determined through experts group discussion. Results During the two rounds of consultation,all the questionnaires were collected,the experts' authority coefficients were 0.936 and 0.926 respec-tively,and the coordination coefficient of expert opinion was statistically significant.Criteria for determination of spu-tum retention included ineffective cough plus auscultation phlegm sound,with or without complaining of sputum,de-creased blood oxygen saturation,difficulty breathing and cyanosis. Conclusion Based on expert consultation and ar-gument,the criteria for determination of sputum retention can facilitate clinical nurses to detect sputum retention.