Ventilator-Associated Pneumonia in Patients Admitted to Intensive Care Units, Using Open or Closed Endotracheal Suctioning

Abstract

Background:Critically ill patients under mechanical ventilation require frequent suctioning of airway secretion. Closed suction permits suctioning without disconnection from ventilator; so it might decrease hypoxemia and infection rate.Objectives:This study aimed to evaluate the effect of closed tracheal suction system (CTSS) versus open tracheal suction system (OTSS).Patients and Methods:This is a prospective randomized study, which was carried on 100 patients in surgical Intensive Care Unit requiring mechanical ventilation for more than 48 hours from June 2012 to November 2013. In two groups, suction was performed based on the patients' need as well as physician's or nurses' decision on tracheal secretions. Patients randomly allocated into two groups (50 patients each): CTSS group and OTSS group. Patients were monitored for developing ventilator-associated pneumonia (VAP) during the study. Throat samples were taken on admission and two times per week from each patient. Tracheal samples were performed during endotracheal intubation, two times per week during mechanical ventilation and during extubation.Results:Drainage of subglottic secretions decreased the incidence of VAP (P < 0.05). Also type of the pharmacologic medicine for stress ulcer prophylaxis has significant effect on VAP incidence. Among the patients in OTSS and CTSS groups, 20% and 12% developed VAP, respectively. Use of CTSS compared with OTSS did not show statistically significant effect on VAP incidence in multivariate analysis; however, OR (odds ratio) tended to identify OTSS as an exposure factor for the development of VAP (OR = 1.92; CI = 0.45-8.30; = 0.38) compared with the CTSS. Higher levels of APACHE II score, sinusitis and tracheostomy put the patients at the risk of VAP. However, using heat and moisture exchanger (HME) instead of humidifier decreased this risk.Conclusions:Based on the results obtained from our study, impact of suctioning is similar between CTSS and OTSS regarding the occurrence of VAP. It seems that physicians must consider many factors such as duration of mechanical ventilation, comorbidities, oxygenation parameters, number of required suctioning, and the cost prior to using each type of tracheal suction system.

Bacterial Contamination from Intraoperative Endotracheal Suctioning in Songklanagarind Hospital

“…Similar VAP rates were found in the earlier trials compared between the closed and the open endotracheal suction system [5,[17][18][19][20]. 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, the contaminating bacteria from the initial pass of the suction can grow in the warm, humid plastic sheath [3]. Many studies reported that the type of the tracheal suction; opened versus closed, had no effect on development of VAP [4][5][6]. Bacterial contamination has been reported from the gloves and equipments such as ventilators [7].…”

Bacteriologic Evaluation of Ventilator-Associated Pneumonia According to Stress Related Mucosal Disease Prophylaxis in the Intensive Care Unit

“…Multiple factors such as central nervous system diseases, level of consciousness and position of patients, along with ventilator circuit and increase in bacterial bioburden of the upper respiratory and orogastric tracts prepare the condition to establish nosocomial pneumonia. Among the factors that have an effect on the bacterial bioburden of the upper respiratory and orogastric tracts, the role of hospital stay duration, prolonged antibiotic exposures, and gastric acid suppression are prominent (4,(11)(12)(13)(14)(15). Interventions and strategies to eradicate oropharyngeal and/or intestinal microbial colonization, such as chlorhexidine oral care, prophylactic aerosolization of antimicrobials, selective decontamination of the digestive tract (SDD), use of sucralfate rather than H for stress ulcer prophylaxis, enteral feeding strategies that preserve gastric pH and also semirecumbent positioning, head elevation, or continuous subglottic suctioning have been frequently used to decrease the incidence of VAP (28- In contrast to a few studies that claimed that routine prophylaxis for stress-related bleeding, even in high-risk patients, seems to not be justified (18), several assessments in high-risk patients (ventilated for > 48 hrs.…”

“…There are some factors that make the patient vulnerable to develop nosocomial and ventilator-associated pneumonia. One of these important factors is the increase in the bacterial burden of the upper respiratory and orogastric tracts due to prolonged hospitalization, antibiotic exposure, and gastric acid suppression (4,(11)(12)(13)(14)(15). There are several studies that have been conducted among critically ill and mechanically ventilated patients for evaluating the effect of different gastrointestinal prophylactic agents, other than pantoprazole, on bleeding prevention, and nosocomial pneumonia occurrence (16)(17)(18)(19)(20)(21)(22).…”

Efficacy of the Closed Suction Applied To Patients In Intensive Care Units with Different Techniques: A Nonrandomized Controlled Trial

“…Presence of intubation increases the secretion production in the respiratory tract [8][9][10] and patients cannot clear these secretions from their respiratory tract by themselves. Thus, accumulation of secretions in the respiratory tract can lead to mechanical obstructions and suctioning of the patient becomes inevitable depending on the patient's need 11 .…”