6. Conclusion
There is sufficient evidence to conclude that NSI before endotracheal
suctioning, which is used to soften and easily remove secretions,
significantly decreases the patient's oxygenation. However, the impact
of NSI on the sputum amount, hemodynamics, and VAP incidence
remains controversial. When considered together, there is no strong
evidence that NSI is a useful procedure. The existing evidence suggests
that practitioners should not use this procedure. However, in clinical
practice, although nurses believe that there may be adverse effects,
they continue to widely use NSI in the management of thick and tenacious
secretions. So, additional randomized clinical trials are needed to
determine the effectiveness of applications that may be alternatives to
normal saline instillation in the management of these secretions