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Closed versus open endotracheal tube suction in mechanically ventilated neonates: a randomized controlled trial

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Abstract

This study aimed to evaluate the effect of closed versus open endotracheal tube suction in reducing ventilator-associated pneumonia in mechanically ventilated neonates. In this open-label, parallel-group, randomized controlled trial with allocation concealment, ventilated neonates (≥ 28 weeks and ≥ 800 g) were either allocated to the closed-suction group (n = 41) or open-suction group (n = 39). The ventilator circuit of the babies enrolled in the closed-suction group was attached to the closed-suction catheter on the requirement of their first suction, and it was changed after every 48 h or earlier if visibly soiled whereas babies enrolled in the open-suction group were suctioned with a new suction catheter each time they require suction. The primary outcome was the incidence of VAP per 1000 days. Baseline maternal and neonatal characteristics were comparable between the two groups. The proportion of neonates with VAP in the closed-suction group was 3 (7.3%) and 1 (2.6%) in the open-suction group with an RR of 2.8 (95% CI: 0.30–26.28) and a p-value of 0.35. The incidence of VAP in the closed-suction group was 3.9 per 1000 ventilator days and 1.3 per 1000 ventilator days in the open-suction group. The incidence of clinical VAP/1000 ventilator days was 33.63 ± 22.96 in the closed-suction group and 28.67 ± 12.32 in the open-suction group with a mean difference of 5 (95% CI: − 3.26 to 13.26) and p-value of 0.24.

Conclusion: In a unit with a low incidence of VAP, the effect of the endotracheal suction method alone did not impact the occurrence of VAP in the study population.

Clinical trial registration: CTRI/2020/03/023679; Date: 17.02.2020.

What is Known:

• Better physiological stability of the closed-suctioning method on short-term measures including noticeably fewer episodes of hypoxia, a smaller drop in TcPO2 levels, and less variability in heart rate and bradycardia episodes.

What is New:

• In a unit with a low incidence of VAP in the neonates, randomized control trial studying the effect of the endotracheal suction method alone did not impact the occurrence of VAP amongst the study population.

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Data availability

The data that support the findings of this study are not available publicly due to ethical reasons but are available with the authors and could be produced upon reasonable request.

Abbreviations

BPD:

Bronchopulmonary dysplasia

CDC:

Center for disease control and prevention

IVH:

Intraventricular hemorrhage

PVL:

Periventricular leukomalacia

NICHD:

National institute of child health and human development

NICU:

Neonatal intensive care unit

NNIS:

National nosocomial infection surveillance

RBSK:

Rashtriya Bal Swasthya Karyakram

SNAPPE:

Score for neonatal acute physiology with perinatal extension

VAP:

Ventilator-associated pneumonia

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Authors and Affiliations

  1. Department of Neonatology, Government Medical College Hospital, Chandigarh, India

    Ajaya Kumar Gahan, Suksham Jain, Supreet Khurana & Deepak Chawla

Authors
  1. Ajaya Kumar Gahan
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  2. Suksham Jain
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  3. Supreet Khurana
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  4. Deepak Chawla
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Dr. Ajaya Kumar Gahan, Dr. Suksham Jain, Dr. Supreet Khurana, and Dr. Deepak Chawla. The first draft of the manuscript was written by Dr. Ajaya Kumar Gahan, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Suksham Jain.

Ethics declarations

Ethics approval

The study was approved by the ethics committee of GMCH (no. GMCH/IEC/2019/236, dt. 30/12/2019).

Consent to participate

Written informed consent was obtained from the parents of all participants.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca

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Article summary: Closed-suction method as compared to the open-suction method should decrease VAP in mechanically ventilated neonates. The current study was done to assess the same.

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Gahan, A.K., Jain, S., Khurana, S. et al. Closed versus open endotracheal tube suction in mechanically ventilated neonates: a randomized controlled trial. Eur J Pediatr 182, 785–793 (2023). https://doi.org/10.1007/s00431-022-04726-y

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