Background
Studies designed to determine the impact of NSI before endotracheal
suctioning, which is a practice that is commonly used in intensive care
units, have been performed since the 1970s. Demers and Saklad [7]
indicated that water and mucus do not blend in an in vitro environment.
Hanley et al [8] reported that only 10.7% to 18.7% of a saline solution can
be retrieved with suctioning and that the portion that remains in the
lungs negatively affects gas exchange. In that respect, the reduction of oxygen
saturation after NSI and the increased risk of ventilator-associated
pneumonia (VAP) have been supported by studies [9,10]. In addition,
Hagler and Traver [11] demonstrated in a laboratory environment that
the use of NSI caused bacteria to move toward the lower airway