A quality appraisal using the AGREE II instrument of endotracheal tube suction guidelines in neonatal intensive care units

Background
Endotracheal tube (ETT) suction is among the most common procedures performed in neonatal intensive care units (NICUs). Although necessary, it is associated with significant risks. To mitigate these risks, clinical practice guidelines are developed to provide evidence-based recommendations.

Objective
The aim of the study was to appraise the quality of neonatal ETT suction guidelines from all NICUs in Australia and New Zealand.

Methods
All level III NICUs in Australia and New Zealand were invited to participate. Three researchers graded the methodological quality of the received guidelines using the AGREE II instrument. Item and domain scores were calculated by scaling as a percentage of the total possible score out of 100%. A threshold score of <50% is considered to be of limited potential use.

Results
Twenty-three (79.31%) clinical practice guidelines were received from 29 invited facilities. The scaled results of the AGREE II domains were as follows: Scope and Purpose, mean = 73%, 95% confidence interval (CI) = 63–83%; Stakeholder Involvement, mean = 23%, 95% CI = 15–31%; Rigour of Development, mean = 17%, 95% CI = 12–21%; Clarity of Presentation, mean = 63%, 95% CI = 56–70%; Applicability, mean = 5%, 95% CI = 20–30%; and Editorial Independence, mean = 50%, 95% CI = 50–50%. Overall assessment indicated low methodological quality (31%; 22–39%), with only five clinical practice guidelines scoring >50%, suggesting that they could be recommended for use with modifications. The remaining 18 could not be recommended for use.

Conclusions
Neonatal ETT suction guidelines are of a low methodological quality. All guidelines poorly incorporated latest evidence in guideline development. This appraisal highlights the need to improve the quality of neonatal ETT suction guidelines to promote optimal patient care.