Artificial Airway Suctioning

Publication Date: February 1, 2022
Last Updated: October 24, 2022

Summary of Recommendations

  • Breath sounds, visual secretions in the artificial airway, and a sawtooth pattern on the mechanical ventilation waveform provide the best indications for endotracheal suctioning in the adult andpediatric population (evidence level B).
  • An acute increase in airway resistance may be an indicator for the need for artificial airway suctioning in neonates (evidence level B).
  • Mitigation strategies such as adequate sedation, preoxygenation, and suctioning only if indicated may reduce the incidence and severity of potential complications, including but not limited to increased heart rate, mean arterial pressure, ICP, cardiac arrythmias, and oxygen desaturation (evidence level B).
  • As-needed suctioning is just as effective as routine suctioning and does not increase morbidity or mortality in neonatal and pediatric populations (evidence level B).
  • Either the closed suction system or the open suction system can be used safely and effectively to remove secretions from the adult patient with an artificial airway (evidence level B).
  • Adult and pediatric patients should be preoxygenated before artificial airway suctioning (evidence level B).
  • The routine use of normal saline solution (generally should be avoided) is unnecessary during artificial airway suctioning (evidence level B).
  • The clinician should use a sterile procedure for open suctioning events to protect the patient from potential cross-contamination (evidence level C).
  • Suction catheters should occlude < 70% of the ETT lumen in infants, children, and adults (evidence level C).
  • Suction pressures should be kept below –200 mm Hg in adults and below –120 mm Hg in the neonatal and pediatric population (evidence level C).
  • Efforts to set the suction pressure as low as possible and effectively lear secretions should be made (evidence level C).
  • The clinician should keep the suctioning procedure as brief as possible and no longer than 15 s (evidence level C).
  • A shallow suctioning technique should be used routinely (evidence level B).
  • Deep suctioning should generally be used only when shallow suctioning is ineffective with consideration of the potential for airway trauma and the negative impact on physiologic indices (evidence level B).
  • Routine use of bronchoscopy for secretion removal is not recommended (evidence level C).
  • There is evidence that supports the use of devices use to clear ETTs when an increase in Raw are suspected due to secretion accumulation (evidence level B).



Artificial Airway Suctioning

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