Impact of the suctioning system (open vs. closed) on the incidence of ventilation-associated pneumonia: meta-analysis of randomized controlled trials
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Ventilation-associated pneumonia (VAP) is a serious complication of patients in intensive care units (ICU) who require mechanical ventilation. The choice of suctioning system (open vs. closed) remains unresolved in evidence-based guidelines. This meta-analysis was carried out to analyze the effect of the type of suctioning system on the incidence of VAP.
A search of the literature was used to identify randomized controlled trials addressing this question. A meta-analysis was then performed to calculate the relative risk of ventilation-associated pneumonia acquisition with the two suctioning systems.
Nine trials were included, with 648 patients in the open suctioning group and 644 in the closed suctioning group. VAP occurred in 128 (20%) of the open suctioning group and in 120 (19%) in the closed suctioning group (relative risk 0.95).
At a given pneumonia prevalence of 20% in ICU patients there was no significant advantage for the use of either suctioning system in this meta-analysis. The choice of suctioning system should therefore be based on handling, cost, and individual patient's disease until more data are available.
KeywordsSuctioning systems Meta-analysis Nosocomial pneumonia
- 12.Deppe SA, Kelly JW, Thoi LL, Chudy JH, Longfield RN, Ducey JP, Truwit CL, Antopol MR (1990) Incidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using a Trach Care closed-suction system versus an open-suction system: prospective, randomized study. Crit Care Med 18:1389–1393PubMedCrossRefGoogle Scholar
- 17.Rabitsch W, Kostler WJ, Fiebiger W, Dielacher C, Losert H, Sherif C, Staudinger T, Seper E, Koller W, Daxbock F, Schuster E, Knobl P, Burgmann H, Frass M (2004) Closed suctioning system reduces cross-contamination between bronchial system and gastric juices. Anesth Analg 99:886–892PubMedGoogle Scholar
- 21.Subirana M, Sola I, Garcia JM, Laffaire E, Benito S (2003) Closed tracheal suction systems versus open tracheal systems for mechanically ventilated adult patients. The Cochrane Database of Systematic Reviews: protocols 2003 3Google Scholar
- 28.DePew CL, Moseley MJ, Clark EG, Morales CC (1994) Open vs closed-system endotracheal suctioning: a cost comparison. Crit Care Nurs 14:94–100Google Scholar