Endotracheal Colonization and Ventilator-associated Pneumonia in Mechanically Ventilated Patients according to Type of Endotracheal Suction System

Cha, Kyeong-Sook; Park, Ho-Ran

doi:10.4040/jkan.2011.41.2.175

Cited by 9 publications

(10 citation statements)

References 21 publications

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“…Closed suction systems may be more effective for the ICU environment where ICU bed density is too high. In fact, some Korean studies showed closed suction system outperforms open suctioning in reducing infections [9][10][11]. In this study, there were no differences between the experimental and control catheters with respect to the incidence of hypoxia, hemodynamics, infection and ICU length of stay probably because both were closed-suction catheters.…”

contrasting

confidence: 66%

“…Closed suctioning, backed by continuous supply of oxygen and positive end-expiratory pressure, is said to provide physiological stability and reduce the risk of nosocomial infection by keeping ventilator circuit closed. [6][7][8][9][10][11][12] However, its efficacy in preventing infections is still debated. [13,14] Newly developed closed-suction catheter (AceTrachcare, AceMedical Co., Republic of Korea) has dial-type pressure valve, located on the suction port, enables physicians to vary the level of suction pressure depending on the amount of secretions ( Fig.…”

Section: Introductionmentioning

confidence: 99%

“…However, the total number of suctioning performed with the experimental catheter and the control catheter for 48 hours was not significantly different. We therefore postulate that suctioning efficiency of the two catheters was similar.Closed-suction catheter is widely used in the ICU due to favorable outcomes, including improved oxygenation, reduced hypoxia, positive end-expiratory pressure maintenance and subsequent decrease in atelectasis and decreased risk of nosocomial infection [6][7][8][9][10][11][12]. Closed suction systems may be more effective for the ICU environment where ICU bed density is too high.…”

mentioning

confidence: 98%

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A Closed-Suction Catheter with a Pressure Valve Can Reduce Tracheal Mucosal Injury in Intubated Patients

Jeong

Nam

Cho

et al. 2014

Korean J Crit Care Med

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Background: Endotracheal suctioning is associated with complications that include bleeding, infection, hypoxemia, cardiovascular instability, and tracheal mucosal injury. Recently, a closed-suction catheter with a pressure valve (Acetrachcare, AceMedical Co., Republic of Korea) was developed. We hypothesized that this new catheter might reduce tracheal mucosal injury compared to a conventional closed-suction catheter (Trachcare, Kimberly-balla RD, USA). Methods: This prospective, randomized study enrolled medical and surgical patients who required mechanical ventilation for more than 48 hours. Patients were randomized into two groups: one group was suctioned with the conventional closed-suction catheter (CCC) and the other group was suctioned with the closed-suction catheter with pressure valve (CCPV). Bronchoscopy was performed 48 hours later, and the severity of tracheal mucosal injury was graded on a 5-point scale, as follows: 0 = normal; 1 = erythema or edema; 2 = erosion; 3 = hemorrhage; and 4 = ulceration or necrosis. Results: A total of 76 patients (37 with CCPV and 39 with CCC) were included. There were no significant differences between the groups regarding demographic characteristics, changes in hemodynamic parameters during suction, incidence of pneumonia, length of intensive care unit (ICU) stay, or ICU mortality. On bronchoscopic evaluation, the use of the CCPV led to a significant decrease in tracheal mucosal injury (median tracheal mucosal injury grade 1 [IQR 0-1] vs. 2 [IQR 1-3], p = 0.001). Conclusions: We conclude that the novel closed-suction catheter with pressure valve may reduce tracheal mucosal injury compared to conventional catheters.

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contrasting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 98%

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A Closed-Suction Catheter with a Pressure Valve Can Reduce Tracheal Mucosal Injury in Intubated Patients

Jeong

Nam

Cho

et al. 2014

Korean J Crit Care Med

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“…A CSS can reduce contamination in the respiratory system because it allows endotracheal suctioning without disconnection of the patient from the ventilator. 39 Selection of an appropriate size SC in a CSS can help conserve the minute volume and PEEP to improve the clinical signs of hypoxemia and limit environmental, personnel, and patient contamination during suctioning. Therefore, closed system suctioning may be particularly beneficial in critically ill patients with respiratory conditions, such as patients with COVID-19.…”

Section: Comparison With Past Study Findingsmentioning

confidence: 99%

Optimizing effects on airway pressure and minute volume during closed endotracheal suctioning: a simulated lung model

et al. 2021

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A closed suction system is used to remove endotracheal secretions without interrupting the patient’s ventilation. Closed suctioning may reduce adverse effects associated with suctioning with, for example, decreased clinical signs of hypoxemia and limited environmental, personnel, and patient contamination. However, it is not clear whether ventilation is maintained during the procedure. We aimed to determine the effects of endotracheal tube (ETT) size, suction catheter (SC) size, and SC length in the ETT on ventilation parameters measured during suction. Suction was performed on a test lung, ventilated with either volume-controlled continuous mandatory ventilation (VC-CMV) or pressure-controlled continuous mandatory ventilation (PC-CMV) using ETT sizes of 6.0–8.5 mm paired with SC sizes of 8–16 French gauge (Fr = 0.33 mm). Airway resistance ( Raw), peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), and expiratory minute volume ( Vexp) were recorded for each ventilation episode by a HAMILTON-G5 ventilator. Here, Raw was considerably increased by insertion of the SC into the ETT. This Raw effect altered the PIP and Vexp. PIP was increased in VC-CMV because the ventilation area of the ETT was reduced, and Vexp was decreased in PC-CMV in relation to the size of the SC. PEEP decreased with application of the 16 Fr SC and 30 L/min flow rate in VC-CMV. We conclude that airway pressure and minute volume are not maintained during closed endotracheal suctioning with VC-CMV and PC-CMV, respectively. The degree of interference to ventilation is affected through selection of appropriate SC size and ventilation settings.

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“…Colonized resistant strains can spread to other patients or contaminate the hospital surroundings via transmission by the medical staff or medical devices [14]. Pneumonia, in particular, increases mortality and disease prevalence and is a critical threat to patient safety [16]. The health-care cost of HAIs is considerable [14], and the annual cost of managing these infections at a 100-bed hospital has been estimated at 78,511,500 KRW [17].…”

Section: Introductionmentioning

confidence: 99%

Who Comes to the Emergency Room with an Infection from a Long-term Care Hospital? A Retrospective Study Based on a Medical Record Review

Kim

Jang

2018

Asian Nursing Research

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Purpose: Health careeassociated infections increase disease prevalence and mortality and are the main reason for the hospitalization of the elderly. However, the management of underlying infections in patients hospitalized in long-term care hospitals (LTCHs) is insufficient, and the transfer of these poorly managed patients to the emergency room (ER) of an acute care hospital can lead to rapid spread of infection. This study investigated the risk factors associated with an ER visit due to infections that developed in LTCHs. Methods: The electronic medical records of patients who were transferred to the ER of a university hospital in South Korea were used. Infection prevalence, causative infectious agent, and antibiotic sensitivity were assessed. The associations between patient characteristics and hospital-associated infections were examined using multiple logistic regression analyses. Results: Among the 483 patients transferred to the ER during the study period, the number of infection cases was 197, and 171 individuals (35.4%) had one or more infections, with pneumonia being the most common (52.8%), followed by urinary tract (21.3%) and bloodstream (17.8%) infections. Patients with bedsores, fever, an indwelling catheter, and a higher nursing need were more likely to be seen in the ER because of infectious disease from an LTCH. Conclusion: Both an intensive care system and surveillance support should be established to prevent infections, particularly in high-risk patients at LTCHs.

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Endotracheal Colonization and Ventilator-associated Pneumonia in Mechanically Ventilated Patients according to Type of Endotracheal Suction System

Cited by 9 publications

References 21 publications

A Closed-Suction Catheter with a Pressure Valve Can Reduce Tracheal Mucosal Injury in Intubated Patients

A Closed-Suction Catheter with a Pressure Valve Can Reduce Tracheal Mucosal Injury in Intubated Patients

Optimizing effects on airway pressure and minute volume during closed endotracheal suctioning: a simulated lung model

Who Comes to the Emergency Room with an Infection from a Long-term Care Hospital? A Retrospective Study Based on a Medical Record Review

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