Closed Endotracheal Suction Systems for COVID-19: Rapid Review

Abstract

Background The increase in admissions to intensive care units (ICUs) in 2020 and the morbidity and mortality associated with SARS-CoV-2 infection pose a challenge to the analysis of evidence of health interventions carried out in ICUs. One of the most common interventions in patients infected with the virus and admitted to ICUs is endotracheal aspiration. Endotracheal suctioning has also been considered one of the most contaminating interventions. Objective This review aims to analyze the benefits and risks of endotracheal suctioning using closed suction systems (CSS) in COVID-19 patients. Methods A rapid review was carried out using the following databases: PubMed, MEDLINE, CINAHL, LILACS, the Cochrane Library, and IBECS. The data search included articles in English and Spanish, published between 2010 and 2020, concerning adult patients, and using the key words “endotracheal,” “suction,” and “closed system.” Results A total of 15 articles were included. The benefits and risks were divided into 3 categories: patient, care, and organization. Relating to the patient, we found differences in cardiorespiratory variables and changes in the ventilator, for example, improvement in patients with elevated positive and end-expiratory pressure due to maladaptation and alveolar collapse. Relating to care, we found a shorter suctioning time, by up to 1 minute. Relating to organization, we found fewer microorganisms on staff gloves. Other conflicting results between studies were related to ventilator-associated pneumonia, bacterial colonization, or mortality. Conclusions Aside from the need for quality research comparing open suction systems and CSS as used to treat COVID-19 patients, closed endotracheal suctioning has benefits in terms of shorter stay in the ICU and reduced environmental contamination, preventing ventilator disconnection from the patient, reducing the suctioning time—though it does produce the greatest number of mucosal occlusions—and preventing interpatient and patient-staff environmental contamination. New evidence in the context of the SARS-CoV-2 virus is required in order to compare results and establish new guidelines.

Nursing Practice of Airway Care Interventions and Prone Positioning in ICU Patients with COVID-19—A Dutch National Survey

“…Another intervention, likely motivated by the desire to minimize the exposure of healthcare professionals to the potential risk of contamination with COVID-19 aerosols, is the reported use of closed suction systems by all respondents. It is noteworthy that in an earlier report closed suction systems failed to reduce cross-transmission in ICU patients [31]. Additionally, the American Association for Respiratory Care (AARC) 2022 guidelines state no significant differences in any outcome and recommends both systems to be safe and effective [32].…”

Open Versus Closed Suctioning in Invasively Ventilated Critically Ill Patients for Sustainability of ICU Care: A Life-Cycle Assessment Comparison

“…A recent review showed no difference in patient outcomes, including ventilator-associated pneumonia and mortality, between the 2 systems. 12 With closed suctioning, the ventilation circuit remains intact, preventing possible contamination from aerosols. 4 Ventilation and PEEP settings are believed to be maintained with a closed suctioning system, although this is not confirmed in a bench study.…”

“…On the other hand, a closed suctioning system is known to reduce the amount of nursing time by 40%. 12 More research is needed to further evaluate cost-effectiveness and workload of suctioning systems.…”