Best available evidence on artificial airway suctioning in critically ill older adults: An evidence-based synthesis

This study aims to identify and synthesize the best available evidence on the suctioning process for artificial airways in critically ill elderly patients, including suctioning indications, preparation before suctioning, suctioning methods, subglottic suction, and organizational policies, in order to provide evidence-based resources for clinical application. A comprehensive literature search was conducted across multiple databases and evidence sources, including UpToDate, BMJ Best Practice, Cochrane Library, Joanna Briggs Institute (Australia), Cumulative Index to Nursing and Allied Health Literature, PubMed, National Institute for Health and Care Excellence, Evidence-Based Medicine Database, Ovid Full-Text Medical Journal Database, China National Knowledge Infrastructure, Wanfang Database, China Biomedical Database, the Chinese Guideline Network, the World Health Organization official website, and national geriatric medicine associations and critical care associations. The search encompassed publications from database inception through September 2025. Following methodological quality appraisal, relevant evidence was extracted and synthesized. Thirteen studies met the inclusion criteria, comprising 4 clinical guidelines, 4 expert consensus statements, 1 meta-analysis, 1 evidence summary, and 3 group standards. A total of 20 evidence statements were extracted, addressing 6 key domains: indications for suctioning, pre-suction preparation, suctioning techniques, post-suction care, subglottic suctioning, and institutional policy recommendations. This synthesis provides a comprehensive, multi-dimensional summary of the best available evidence on artificial airway suctioning in critically ill older adults offering a reference framework to inform clinical decision-making and optimize care practices. • Synthesized 20 best evidence items for elderly ICU patients' airway suctioning across 6 key domains. • Identified notable gaps between clinical practices and evidence-based suctioning guidelines. • Highlighted study limitations and proposed targeted research and clinical training needs.