Artificial airway suctioning is a key component of airway management and a core skill for clinicians charged with assuring airway patency. Suctioning of the artificial airway is a common procedure performed worldwide on a daily basis. As such, it is imperative that clinicians are familiar with the most-effective and efficient methods to perform the procedure. We conducted a systematic review to assist in the development of evidence-based recommendations that pertain to the care of patients with artificial airways. From our systematic review, we developed guidelines and recommendations that addressed questions related to the indications, complications, timing, duration, and methods of artificial airway suctioning. By using a modified version of the RAND/UCLA Appropriateness Method, the following recommendations for suctioning were developed for neonatal, pediatric, and adult patients with an artificial airway: (1) breath sounds, visual secretions in the artificial airway, and a sawtooth pattern on the ventilator waveform are indicators for suctioning pediatric and adult patients, and an acute increase in airway resistance may be an indicator for suctioning in neonates; (2) as-needed only, rather than scheduled, suctioning is sufficient for neonatal and pediatric patients; (3) both closed and open suction systems may be used to safely and effectively remove secretions from the artificial airway of adult patients; (4) preoxygenation should be performed before suctioning in pediatric and adult patients; (5) the use of normal saline solution should generally be avoided during suctioning; (6) during open suctioning, sterile technique should be used; (7) suction catheters should occlude < 70% of the endotracheal tube lumen in neonates and < 50% in pediatric and adult patients, and suction pressure should be kept below –120 mm Hg in neonatal and pediatric patients and –200 mm Hg in adult patients; (8) suction should be applied for a maximum of 15 s per suctioning procedure;(9) deep suctioning should only be used when shallow suctioning is ineffective; (10) routine bronchoscopy for secretion removal is not recommended; and (11) devices used to clear endotracheal tubes may be used when airway resistance is increased due to secretion accumulation.

人工气道吸痰是气道管理的关键组成部分，也是负责确保气道通畅的临床医生的核心技能。人工气道的抽吸是全球每天进行的常见手术。因此，临床医生必须熟悉最有效和最高效的手术方法。我们进行了一项系统性综述，以帮助制定与人工气道患者护理相关的循证建议。根据我们的系统综述，我们制定了指南和建议，解决了与人工气道吸痰的适应症、并发症、时机、持续时间和方法相关的问题。通过使用改良版本的 RAND/UCLA 适当性方法，为有人工气道的新生儿、儿童和成人患者制定了以下吸痰建议：(1) 呼吸音、人工气道中的可见分泌物和呼吸机波形上的锯齿状图形是吸痰儿童和成人患者的指标，气道阻力急性增加可能是新生儿吸痰的指标；(2) 仅按需，而不是按计划，吸痰足以用于新生儿和儿童患者；(3) 密闭式和开放式吸痰系统均可用于安全有效地清除成人患者人工气道中的分泌物；(4) 儿童和成人患者吸痰前应进行预氧合；(5) 吸痰时一般应避免使用生理盐水溶液；(6) 开放式吸痰时，应使用无菌技术；(7) 吸痰导管应堵塞 < 新生儿气管插管管腔的70%，儿童和成人患者 < 50%，新生儿和儿童患者的吸引压力应保持在-120 mmHg 以下，成人患者应保持在-200 mmHg 以下；(8) 每次吸痰操作最多应用 15s 的吸引；(9) 仅在浅吸痰无效时使用深吸痰；(10) 不推荐常规支气管镜检查进行分泌物清除；(11) 因分泌物积聚导致气道阻力增加时可使用用于清理气管插管的器械。