Impact of closed versus open tracheal suctioning systems for mechanically ventilated adults: a systematic review and meta-analysis

Kuriyama, Akira; Umakoshi, Noriyuki; Fujinaga, Jun; Takada, Tadaaki

doi:10.1007/s00134-014-3565-4

Cited by 32 publications

(23 citation statements)

References 53 publications

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“…Furthermore, the patient is not detached from the ventilator and ventilation continues during the suctioning. The patient is also calmer and more willing to cooperate (8). CSS has been suggested for use in patients suffering from acute lung injuries or acute respiratory distress syndrome because such patients’ alveoli are more vulnerable (26).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effect of Open and Closed Endotracheal Suctioning Methods on Pain and Agitation in Medical ICU Patients: A Clinical Trial

2016

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BackgroundEndotracheal suctioning is a necessary procedure practiced by nurses in intensive care units to remove lung secretions. This procedure leads to higher oxygenation levels and reduced breathing difficulties. It also prevents atelectasis, pulmonary infections, and the accumulation of secretions.ObjectivesThe present study aims to compare the effectiveness of open and closed endotracheal suction tube systems on pain and agitation in patients under mechanical ventilation.MethodsA randomized controlled clinical trial was conducted in the general intensive care units of Khatam-ol-Anbia hospital and Sina hospital, Tehran, Iran, in 2015. In total, 60 patients who were qualified to be included in the study were randomly assigned to either the intervention group or the control group. When necessary, suction was carried out for each patient using the standard technique. The patients’ level of pain and agitation was measured in both groups at five stages (before, during, immediately after, 5 minutes after, and 15 minutes after the intervention) using the behavioral pain scale and the Richmond agitation sedation scale.ResultsSignificant statistical differences in the pain and agitation at different times within each of the two groups were observed for both open and closed suction (P > 0.001). However, these changes at different times between the two groups was not significant (P < 0.05).ConclusionsAlthough statistical differences were observed in the levels of pain and agitation in the two groups, the type of suction system did not have any effect on the level of pain and agitation of patients under mechanical ventilation. The researchers recommend that other studies with larger sample sizes should be carried out.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Effect of Open and Closed Endotracheal Suctioning Methods on Pain and Agitation in Medical ICU Patients: A Clinical Trial

2016

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“…22,23 Nevertheless, a large meta-analysis published in 2015 which included data from 16 randomised studies (n=1,929), demonstrated that CSS reduced the risk of VAP compared with OSS (relative risk 0.69, 95% confidence interval 0.54 to 0.87), but did not change the duration of mechanical ventilation or mortality. 7 Data collected in the current study demonstrated that ICUs in Australia and NZ predominantly utilise the CSS approach.…”

Section: Open Vs Closed System Approachmentioning

confidence: 73%

“…1,6 There is emerging evidence that, compared with OSS, CSS reduces the risk of ventilator-associated pneumonia (VAP) 7 but does not influence oxygenation, duration of mechanical ventilation, length of ICU stay, or mortality. 1, [6][7][8][9] In addition to different suctioning approaches, adjuncts such as the use of hyperoxygenation, hyperinflation and saline lavage, are available to mitigate risk and/or optimise sputum yield. There is strong evidence that hyperoxygenation performed before, during and after suctioning helps to minimise desaturation after suctioning.…”

Section: Introductionmentioning

confidence: 99%

Approaches and adjuncts used by physiotherapists when suctioning adult patients who are intubated and ventilated in intensive care units in Australia and New Zealand: A cross-sectional survey

Tan

Harrold

Hill

2017

Australian Critical Care

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Most ICUs in Australia and New Zealand are equipped for closed system suctioning. As hyperoxygenation minimises desaturation during suctioning, there may be scope for a larger proportion of physiotherapists to use this adjunct. The practice of hyperinflation before and after suctioning was uncommon despite the emerging evidence for improved lung compliance with this procedure. Subglottic suctioning was infrequently available as a choice for physiotherapists despite the strong evidence, which suggests an evidence-practice gap.

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“…Meta-analysis also failed to demonstrate a positive impact of closed suction system on VAP, morbidity and mortality compared to the open systems [21][22][23][24]. However, using closed suction system has been demonstrated to decreased in incidence of VAP significantly [2,25]. The use of closed suction system is also recommended as part of a VAP prevention program [1].…”

Section: Resultsmentioning

confidence: 99%

Bacterial Contamination from Intraoperative Endotracheal Suctioning in Songklanagarind Hospital

Kwanruthai¹,

Wirat²,

Sirikarn³

et al. 2020

Int J Respir Pulm Med

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Background: Endotracheal suctioning is a common procedure for intubated patients. In Songklanagarind hospital, the sterile technique for endotracheal suctioning is used routinely in all areas except in the operating theater. Objective: To compare bacterial contamination from endotracheal secretion between the clean and the sterile technique. Methods: This prospective randomized controlled trial in 276 patients of age more than 18-years-old who had American Society of Anesthesiologists (ASA) class I-III and scheduled for elective surgery and had no risk of aspiration were enrolled and randomly assigned into two groups. The patients with general anesthesia with oroendotracheal intubation were included. Endotracheal suctioning was performed by the decision of anesthesiologists or anesthetic nurses with sterile or clean technique regarding the group assignment. Secretion collected from the suction catheter was sent to the microbiology laboratory for microbial culture. The microbiologic bacterial results were reported within 7 days. Patients were followed up for respiratory symptoms every day for 7 days after the surgery. Results: There were the non-pathogenic and pathogenic bacterial growth, and fungus from the culture of endotracheal secretion similarly in both clean and sterile groups. The clean group had positive bacterial growth of 64.2% and the sterile group had 57%. The difference was not statistically significant (p = 0.346). The contamination score in the clean and sterile group were 19 and 15 respectively. The incidence of respiratory symptoms such as a cough without fever was low (5%) postoperatively and there was no postoperative pneumonia in both groups. Conclusion: The incidences of bacterial contamination from endotracheal suctioning with clean and sterile technique were similar. But the clean group tended to has higher contamination than the sterile group.

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Impact of closed versus open tracheal suctioning systems for mechanically ventilated adults: a systematic review and meta-analysis

Abstract: Based on current, albeit limited evidence, it is unlikely that CTSS is inferior to OTSS regarding VAP prevention; however, further trials at low risk of bias are needed to confirm or refute this finding.

Cited by 32 publications

References 53 publications

Comparison of the Effect of Open and Closed Endotracheal Suctioning Methods on Pain and Agitation in Medical ICU Patients: A Clinical Trial

Comparison of the Effect of Open and Closed Endotracheal Suctioning Methods on Pain and Agitation in Medical ICU Patients: A Clinical Trial

Approaches and adjuncts used by physiotherapists when suctioning adult patients who are intubated and ventilated in intensive care units in Australia and New Zealand: A cross-sectional survey

Bacterial Contamination from Intraoperative Endotracheal Suctioning in Songklanagarind Hospital

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