The Effects of Open and Closed Suction Methods on Occurrence of Ventilator Associated Pneumonia; a Comparative Study
Archives of Academic Emergency Medicine,
Vol. 8 No. 1 (2020),
7 January 2020
Introduction: Endotracheal suctioning is a method commonly used to clean airway secretions in patients under mechanical ventilation (MV). This study aimed to compare the effects of open and closed suction methods on the occurrence of ventilator associated pneumonia (VAP).
Methods: This comparative study was carried out on adult intensive care unit (ICU) patients in need of MV for more than 48 hours, from October 2018 to January 2019. Patients were randomly allocated to either closed tracheal suction system (CTSS) group or open tracheal suction system (OTSS) group. Patients were monitored for developing VAP within 72 hours of intubation and the findings were compared between groups.
Results: 120 cases with the mean age of 57.91Â±19.9 years were randomly divided into two groups (56.7% male). The two groups were similar regarding age (p = 0.492) and sex (p = 0.713) distribution. 22 (18.3%) cases developed VAP (12 (20%) in OSST group and 10 (16.7%) in CSST; p = 0.637). The most prevalent bacterial causes of VAP were Acinetobacter_Baumannii (72.7%), Klebsiella pneumoniae (18.2%), and Methicillin-Resistant Staphylococcus aureus (9.1%), respectively. There was not any significant difference between groups regarding the mean duration of remaining under MV (p = 0.623), mean duration of hospitalization (p = 0.219), frequency of VAP (p = 0.637), and mortality (p = 0.99).Â
Conclusion: It seems that type of endotracheal suction system (OSST vs. CSST) had no effect on occurrence of VAP and other outcomes such as duration of need for MV and ICU stay as well as mortality.
- critical care
- intensive care units
How to Cite
Charles MP, Kali A, Easow JM, Joseph NM, Ravishankar M, Srinivasan S, et al. Ventilator-associated pneumonia. The Australasian medical journal. 2014;7(8):334-44.
Keyt H, Faverio P, Restrepo MI. Prevention of ventilator-associated pneumonia in the intensive care unit: a review of the clinically relevant recent advancements. The Indian journal of medical research. 2014;139(6):814-21.
Liu XW, Jin Y, Ma T, Qu B, Liu Z. Differential Effects of Endotracheal Suctioning on Gas Exchanges in Patients with Acute Respiratory Failure under Pressure-Controlled and Volume-Controlled Ventilation. BioMed research international. 2015;2015:941081.
Vijai MN, Ravi PR, Setlur R, Vardhan H. Efficacy of intermittent sub-glottic suctioning in prevention of ventilator-associated pneumonia- A preliminary study of 100 patients. Indian journal of anaesthesia. 2016;60(5):319-24.
Sarkar M, Niranjan N, Banyal PK. Mechanisms of hypoxemia. Lung India : official organ of Indian Chest Society. 2017;34(1):47-60.
Lasocki S, Lu Q, Sartorius A, Fouillat D, Remerand F, Rouby JJ. Open and closed-circuit endotracheal suctioning in acute lung injury: efficiency and effects on gas exchange. Anesthesiology. 2006;104(1):39-47.
Siempos, II, Vardakas KZ, Falagas ME. Closed tracheal suction systems for prevention of ventilator-associated pneumonia. British journal of anaesthesia. 2008;100(3):299-306.
Kuriyama A, Umakoshi N, Fujinaga J, Takada T. Impact of closed versus open tracheal suctioning systems for mechanically ventilated adults: a systematic review and meta-analysis. Intensive care medicine. 2015;41(3):402-11.
Hamishekar H, Shadvar K, Taghizadeh M, Golzari SE, Mojtahedzadeh M, Soleimanpour H, et al. Ventilator-associated pneumonia in patients admitted to intensive care units, using open or closed endotracheal suctioning. Anesthesiology and pain medicine. 2014;4(5):e21649.
Aliopur N, Toulabi T, Manouchehrian N, Anbari KH, Rahimi Bashar F. A comparison the effect of open and close endotracheal suctioning on hemodynamic status of patient with head trauma hospitalized in intensive care unit. EVIDENCE BASED CARE. 2014;3(4):65-73.
Afshari A, Safari M, Oshvandi K, Soltanian AR. The effect of the open and closed system suctions on cardiopulmonary parameters: time and costs in patients under mechanical ventilation. Nursing and midwifery studies. 2014;3(2):e14097.
Topeli A, Harmanci A, Cetinkaya Y, Akdeniz S, Unal S. Comparison of the effect of closed versus open endotracheal suction systems on the development of ventilator-associated pneumonia. The Journal of hospital infection. 2004;58(1):14-9.
Ebrahimi fakhar H, Rezaei K, Kohestani H. Closed suction effect of pulmonary secretions of Ventilator-associated Pneumonia. Scientific Journal of Kurdistan University of Medical Sciences. 2010;15(2):79-87.
Kassim A, Omuse G, Premji Z, Revathi G. Comparison of Clinical Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines for the interpretation of antibiotic susceptibility at a University teaching hospital in Nairobi, Kenya: a cross-sectional study. Annals of clinical microbiology and antimicrobials. 2016;15:21.
AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respiratory care. 2010;55(6):758-64.
Schurink CAM, Nieuwenhoven CAV, Jacobs JA, Rozenberg-Arska M, Joore HCA, Buskens E, et al. Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability. Intensive care medicine. 2004;30(2):217-24.
Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic â€œblindâ€ bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991;143:1121â€“9.
Combes P, Fauvage B, Oleyer C. Nosocomial pneumonia in mechanically ventilated patients, a prospective randomised evaluation of the Stericath closed suctioning system. Intensive care medicine. 2000;26(7):878-82.
Ozcan MS, Bonett SW, Martin AD, Gabrielli A, Layon AJ, Banner MJ. Abnormally increased power of breathing as a complication of closed endotracheal suction catheter systems. Respiratory care. 2006;51(4):423-5.
Jongerden IP, Buiting AG, Leverstein-van Hall MA, Speelberg B, Zeidler S, Kesecioglu J, et al. Effect of open and closed endotracheal suctioning on cross-transmission with Gram-negative bacteria: a prospective crossover study. Critical care medicine. 2011;39(6):1313-21.
Morrow BM, Mowzer R, Pitcher R, Argent AC. Investigation into the effect of closed-system suctioning on the frequency of pediatric ventilator-associated pneumonia in a developing country. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2012;13(1):e25-32.
Subirana M, Sola I, Benito S. Closed tracheal suction systems versus open tracheal suction systems for mechanically ventilated adult patients. The Cochrane database of systematic reviews. 2007(4):Cd004581.
David D, Samuel P, David T, Keshava SN, Irodi A, Peter JV. An open-labelled randomized controlled trial comparing costs and clinical outcomes of open endotracheal suctioning with closed endotracheal suctioning in mechanically ventilated medical intensive care patients. Journal of critical care. 2011;26(5):482-8.
Liu Q, Yang J, Zhang J, Zhao F, Feng X, Wang X, et al. Description of Clinical Characteristics of VAP Patients in MIMIC Database. Frontiers in pharmacology. 2019;10:62.
Chin T, Kushner B. Antibiotic Utilization Patterns in Patients with Ventilator-Associated Pneumonia: A Canadian Context. 2016;2016:3702625.
Dey A, Bairy I. Incidence of multidrug-resistant organisms causing ventilator-associated pneumonia in a tertiary care hospital: a nine months' prospective study. Annals of thoracic medicine. 2007;2(2):52-7.
Giamarellou H, Antoniadou A, Kanellakopoulou K. Acinetobacter baumannii: a universal threat to public health? International journal of antimicrobial agents. 2008;32(2):106-19.
Joly-Guillou ML. Clinical impact and pathogenicity of Acinetobacter. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2005;11(11):868-73.
Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: emergence of a successful pathogen. Clinical microbiology reviews. 2008;21(3):538-82.
Bozorgmehr R, Bahrani V, Fatemi A. Ventilator-Associated Pneumonia and Its Responsible Germs; an Epidemiological Study. Emergency (Tehran, Iran). 2017;5(1):e26.
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