Background: Suctioning is an integral component of care for patients who are intubated and ventilated in an Intensive Care Unit (ICU). There appears to be no published data of physiotherapy suctioning practices in Australia or New Zealand. Objective: To describe suctioning practices and the factors which have shaped these practices, of experienced physiotherapists working with adults who are intubated and ventilated in an ICU across Australia and New Zealand. Areas of investigation focused on: (i) suctioning approach (i.e. open vs. closed system); (ii) use of adjuncts to suctioning such as hyperoxygenation, hyperinflation and saline lavage; (iii) use of subglottic suctioning and; (iv) factors influencing suctioning practices. Methods: Electronic surveys were emailed to experienced physiotherapists working in ICUs across Australia and New Zealand which had the capacity to intubate and ventilate adult patients for ≥24h. Results: The participation rate was 84.8％ (112/132). Closed suction system was used in most ICUs (97/112, 86.6％). Hyperoxygenation was commonly performed on 'all' or 'most' patients before suctioning (71/112, 63.4％), but less frequently after suctioning (38/112, 33.9％). Hyperinflation was infrequently performed on 'all' or 'most' patients before (22/112, 19.6％) or after suctioning (22/112, 19.6％). Saline lavage and subglottic suctioning were infrequently performed on 'all' or 'most' patients (3/112, 2.7％; 17/112, 15.2％, respectively). 'Personal experience' and 'established practice in the ICU' had the greatest influence on suctioning practices. Conclusion: Most ICUs in Australia and New Zealand are equipped for closed system suctioning. As hyperoxygenation minimises desaturation during suctioning, there may be scope for a larger proportion of physiotherapists to use this adjunct. The practice of hyperinflation before and after suctioning was uncommon despite the emerging evidence for improved lung compliance with this procedure. Subglottic suctioning was infrequently available as a choice for physiotherapists despite the strong evidence, which suggests an evidence-practice gap.%背景:重症监护室(ICU)中,给插管通气的患者吸痰是护理的有机组成部分.在澳大利亚或新西兰,似乎没有公开发表的物理治疗师进行吸痰处理的数据.目的:描述有经验的物理治疗师给予成年患者的吸痰处理及影响因素,患者为澳大利亚和新西兰的ICU中插管通气的患者.调查集中在以下方面:(i)吸痰操作(即打开与关闭吸痰系统);(ii)使用辅助吸痰,如过度氧合、过度充气和生理盐水灌洗;(iii)使用声门下吸痰;(iv)影响吸痰操作的因素.方法:用电子邮件给在ICU工作的有经验的物理治疗师发送电子调查问卷,上述ICU为澳大利亚和新西兰有条件为成年患者插管并行人工通气不少于24小时的ICU.结果:ICU的参与调查率为84.8％(112/132).绝大多数ICU使用密闭式吸痰系统(97/112,86.6％).吸痰前,通常对"全部"或"绝大部分"患者使用高浓度氧合(71/112,63.4％),但吸痰后,过度氧合使用率较低(38/112,33.9％).对"全部"或"绝大部分"患者不常使用过度充气,吸痰前和吸痰后均为22/112(19.6％).对"全部"或"绝大部分"患者,生理盐水灌洗和声门下吸痰均不常使用(分别为3/112,2.7％ 和17/112,15.2％).对吸痰处理影响最大的因素为"个人经验"和"ICU中建立的操作规程".结论:澳大利亚和新西兰的绝大多数ICU均配备密闭式吸痰系统.因为吸痰过程中,高浓度氧合会最大程度地减少血氧饱和不足,这可能是较大比例的物理治疗师使用这一辅助措施的原因.尽管有证据显示,过度充气能改善肺顺应性,这一辅助措施在吸痰前和吸痰后仍不常使用.尽管有强有力的证据支持,物理治疗师们仍然很少选择声门下吸痰,这表明存在证据-实践差距.
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