Evidence-Based Pulmonary Hygiene in a Pediatric ICU: Impact of Reducing Bag Suction

Background: Bag suction, a manual hyperinflation technique, is commonly used in PICUs but lacks standardized guidelines and is not evidence-based. This quality improvement project aimed to evaluate the impact of a reduction in the use of bag suction and related outcomes in a PICU setting. Our goal was to reduce bag suction in mechanically ventilated PICU patients by 50% within 9 months. Methods: An initial audit was conducted to collect baseline data on bag suction practices, total pulmonary hygiene orders, and ventilator length of stay (LOS). This was followed by an educational intervention for PICU staff on 3/23/23 and 4/13/23, focusing on evidence-based practices and the risks associated with routine bag suction. Also, on 5/18/23 workload points for bag suction were no longer accounted for in daily work estimates. Results: Following the educational interventions and the change in workload points, there was a significant and stable reduction in the use of bag suction. The percentage of mechanically ventilated patients with bag suction orders decreased from an initial high of 24% to 11%, achieving the aim of a 50% reduction (Figure 2). The overall percentage of mechanically ventilated patients receiving some form of pulmonary hygiene saw a small reduction from 77 to 71% (Figure 1). Length of mechanical ventilation remained unchanged throughout the study period, indicating that the reduction in bag suction did not prolong mechanical ventilation. Conclusions: The educational intervention and discontinuation of workload points effectively reduced the use of bag suction by over 50% without affecting duration of mechanical ventilation. The stable percentage of patients receiving pulmonary hygiene suggests that bag suction was replaced with evidence-based therapies. These findings highlight the importance of continuous education and demonstrate the potential for sustaining evidence-based changes in clinical practice within PICUs.