Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: A meta-analysis

Abstract

Based on the results of this meta-analysis, there is no evidence to prefer CSS more than OSS.

Regional lung derecruitment after endotracheal suction during volume- or pressure-controlled ventilation: a study using electric impedance tomography

“…However the closed suction system catheters often become colonised by patients´ own respiratory tract microbial flora which could contribute to auto-contamination [56,57]. In two recent meta-analyses there is no evidence supporting the closed suction systems´ supposed ability to prevent VAP [13,58] (see Table 3). During the USA's AIDS epidemic in the early eighties the closed suc to reduce the unwanted side-effects of endotracheal suctioning.…”

“…Two resent meta-analyses on open and closed endotracheal suctioning with special reference to ventilator associated pneumonia and impact on morbidity/mortality found no difference in outcome between the two methods [13,58] (Table 3). Within the same patient there is often a mix between closed and open suctioning procedures [69] and one possible explanation could be that closed suction is converted to open suctioning due to problems with secretion removal.…”

“…Mechanically ventilated patients suffer from accumulation of tracheobronchial secretions due to increased mucus production, impaired cough reflex and depressed mucociliary clearance. To avoid tube occlusion, impairment of gas exchange and increased work of breathing and pulmonary infections, repeated endotracheal suctioning is performed 8-13 times per 24 hours [12,13]. The positive pressure ventilator treatment is life saving but invasive and several animal and human studies imply that it can cause substantial harm to the lung tissue [14][15][16].…”

Actualización Consenso Neumonía asociada a ventilación mecánica: Segunda parte. Prevención

“…Los datos atingentes a neumonía han sido resumidos en un meta-análisis 50 que evaluó en 1.272 pacientes la efectividad del sistema de aspiración cerrado versus abierto y su efecto sobre la NAVM, no encontrando una diferencia signifi cativa (RR 0,96; IC 95 0,76-1,21; p = 0,39). Tampoco hubo diferencia en la mortalidad en UCI en 1.062 pacientes.…”

“…Entre las ventajas del uso del sistema cerrado de aspiración estaría el estar asociado a una menor cantidad de episodios de hipoxia y arritmias; sin embargo, no habiendo diferencia respecto a la incidencia de NAVM ni mortalidad, se debe considerar que no hay diferencias importantes entre ambos sistemas 47, 49,50 . Desde el punto de vista funcional, el sistema cerrado permite que al no desconectar el ventilador durante la aspiración, los pacientes que reciben una presión de fi nal de espiración elevada (PEEP) no pierden este aporte durante la aspiración.…”