Physiotherapy ICU Management Algorithm

USE SALINE AS INDICATED EG TENACIOUS SECRETIONS
I agree with everything except needing to use a strictly aseptic technique. During suctioning, however, the catheter is passed into the ETT through an unsterile port which may be colonized with potentially pathogenic organisms. This will occur regardless of operator sterility. In a randomized controlled trial of 486 intubated children and infants it was found that reusing a disposable suction catheter in the same patient over a 24-hour period did not affect the incidence of nosocomial pneumonia. Similar studies have not been conducted in adults to my knowledge but they are unlikely to be very different in this regard. Reference: Scoble MK, Copnell B, Taylor A, et al.: Effect of reusing suction catheters on the occurrence of pneumonia in children. Heart Lung 2001; 30: 225-233.
I think you have to break down the components. There is strong evidence for for pre-oxygenation, although the optimal level of hyper-oxygenation is not known (eg. Oh H, Seo W: A meta-analysis of the effects of various interventions in preventing endotracheal suction- induced hypoxemia. J Clin Nurs 2003; 12: 912-924.). There is also strong evidence against using saline. However, the evidence relating to frequency of suctioning is fairly weak, and as said before, I disagree with the need for a strictly aseptic/sterile technique.
Again, I think the quality of evidence is different for the different components, and do not think they can be lumped together as a single recommendation. The issues relating to saline use and pre-oxygenation are fair to good, but those relating to frequency of suctioning is very poor - no well-designed clinical trials have compared the different practices, recommendation mostly based on expert consensus (routine vs on indication)

Expert Opinion: Extubation of patient

AGREEMENT:5/7
DISAGREEMENT:1/7
NO RESPONSE:1/7

Expert Opinion 2: Use of manual techniques

AGREEMENT:4/7
DISAGREEMENT:1/7
NO RESPONSE:2/7