Endotracheal Suctioning Practice Among Respiratory Care Practitioners Based on the AARC 2022 Guidelines: A Cross-Sectional Study in Saudi Arabia

Abstract

Background:

Endotracheal suctioning (ETS) is essential to maintain the patency of the artificial airway. Mastering this skill is a core competency of respiratory therapists (RTs). There have been no research studies on the practice of ETS among RTs in Saudi Arabia; therefore, this study aimed to assess their practice based on the latest (ie, 2022) American Association for Respiratory Care (AARC) evidence-based guidelines.

Methods:

This study utilized a self-administered questionnaire to survey RTs working in critical care units in Saudi Arabia who hold at least one respiratory care degree. The aim was to compare their actual ETS practice with the recommended guidelines set by the AARC. The questionnaire consisted of 22 multiple-choice questions categorized into three domains: demographic data, RTs’ awareness, and adherence to the AARC guidelines. A scoring system was implemented to measure the level of adherence to the AARC recommendations, with answer choices graded on a scale of 0 to 4, as shown in Table 1. The maximum score attainable for complete adherence to the AARC guidelines was 32. The remaining questions were analyzed using summary statistics, presented as mean, standard deviations, and percentages. This study received approval from the Research Ethics Committee of the Faculty of Medicine, King Abdulaziz University (Reference No 259-22).

Results:

Of the 126 individuals who accessed the survey, data from 120 RTs were included in the analysis. The mean score and standard deviation were 21 and 4, respectively, representing a 67% compliance rate (SD 11%). The majority of participants (n = 74, 62%) achieved adherence rates between 60% and 80%. A small number of RTs (n = 8, 7%) had a concerning compliance level of less than 50%, whereas 16 subjects (14%) demonstrated adherence greater than 80%. Figure 1 depicts the RTs’ adherence level to each AARC recommendation.

Conclusions:

The present study found that RTs demonstrated a moderate level of adherence to the AARC's latest ETS guidelines. The recommendations with the lowest compliance were normal saline instillation and ETS performance based on the time intervals. As these procedures are assessment-based, we recommend developing educational and training programs that highlight the significance of assessments in determining the clinical need for ETS.

Figure 1. The absolute degree of adherence to each ETS AARC recommendation.

Table 1. The questions and their answer choices score surveyed.