However, nearly half of the nurses in our study also use different
methods, such as humidification and mucolytic and nebulizer medications,
for managing secretions. These methods were also recommended
in previous reviews [14,15]. However, it is recommended that these
methods be used to prevent the development of mucus plaques, not in
the management of thick and tenacious secretions, as reported by the
nurses participating in our study. In the pilot study that was performed
by Klockare et al [29] with a limited sample number, it was demonstrated
that saline is distributed equally within the lungs when it is applied with
nebulization. However, this result was not statistically significant.
Nevertheless, that study provided important data concerning the activity
of saline within the lungs after application with nebulization. Accordingly,
studies are needed to determine whether applications such as nebulization
prevent thick and tenacious secretion formation and to guide nurses
in the prevention of endotracheal secretions.