Tracheal suction by closed system without daily change versus open system

Abstract

CTSS without daily change is the optimal option for patients needing tracheal suction longer than 4 days.

Comparison of closed endotracheal suction versus open endotracheal suction in the development of ventilator-associated pneumonia in intensive care patients: An evaluation using meta-analytic techniques

“…A single investigator reviewed these abstracts, and 48 Number with ventilator-LOS [ Table 4]. The duration of mechanical one study [28] contributed substantially (93%) [25] 2000 France Y/N Stericath ® Randomly Nil Yes 4 NA NA allocated Zeiuton [26] 2003 Brazil Y/Y NA Alternate day Nil Yes 4 NA NA Randomization Rabitsch [28] 2004 Austria Y/Y Trachcare™ Randomized Yes Yes 7 8 8 (sealed envelopes) Topeli [29] [24] and in one study cost was numbers precluded multi-variate analysis.…”

Comparison of a Closed with an Open Endotracheal Suction: Costs and the Incidence of Ventilator-associated Pneumonia

“…Each way of suctioning was consecutively applied for one month period and one or one and half month of wash out period was interposed between each method. Lorente et al argued that closed tracheal suction system, when it was used for more than 24 hr, does not increase VAP 17 . Therefore, we decided to change the close suction catheter every 48 hrs.…”

Evidence on measures for the prevention of ventilator-associated pneumonia

“…This decrease in the exogenous pneumonia rate could be due to the fact that CTSS avoids direct manipulations of the aspiration catheter, as it is protected by a plastic envelope. Nevertheless, in two recent randomised studies, no significant differences were found between the patients suctioning with CTSS or OTSS in terms of either total VAP incidence or exogenous VAP incidence [104,105]. Thus, the evidence does not support the routine use of CTSS for prevention of VAP.…”

“…For these reasons, CTSS is presumed to offer advantages over OTSS, such as lower gasometric and haemodynamic impairment during the suction of respiratory secretions, which has been found in several studies [94][95][96][97], and a protective effect against VAP, although this latter finding is controversial because only one study has reported a lower incidence of VAP using CTSS [98]. Several other studies have not found significant differences in the incidence of VAP between the systems [99][100][101][102][103][104][105].…”

“…A randomised study recently evaluated the incidence of VAP and the suctioning cost, comparing OTSS and CTSS without daily change [105]. The CTSS used had two parts: 1) a suction catheter (enveloped in a protective plastic); with 2) a suction valve, detachable from the elbow and equipped with a rotating patient access valve (bronchoscope valve).…”