Closed versus Open Tracheal Suction Systems for Ventilator-associated Pneumonia in Adults: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 JIN Ling ¹ , WANG Haiyan ¹ , LI Bin ²

1. The People Hospital of Xinjiang Urgent-care Centre, Urimqi 830054, China; 2. The Department of Orthopaedics, The People Hospital of Xinjiang Urimqi 830054, China;

Corresponding author：

JIN Ling, Email: li_bin1978@126.com

Keywords：

Closed tracheal suction system; Open tracheal suction system; Ventilator-associated pneumonia; Randomized controlled trials; Systematic review

DOI：

10.7507/1672-2531.20080076

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To determine the effect of closed tracheal suction system versus open tracheal suction system on the rate of ventilator-associated pneumonia in adults.
Methods 　We searched The Cochrane Library (Issue 1, 2007), PubMed (1966 to 2006) and CBM (1980 to 2007), and also hand searched relevant journals. Randomized controlled trials involving closed tracheal suction system versus open tracheal suction system for ventilator-associated pneumonia in adults were included. Data were extracted and the quality of trials was critical assessed by two reviewers independently. The Cochrane Collaboration’s RevMan 4.2.8 software was used for data analyses.
Result 　Five randomized controlled trials involving 739 patients were included. Results of meta-analyses showed that compared to open tracheal suction system, closed tracheal suction system did not increase the rate of ventilator-associated pneumonia (RR 0.83, 95%CI 0.50 to 1.37) or case fatality (RR 1.05, 95%CI 0.85 to 1.31). No significant differences were observed between open tracheal suction system and closed tracheal suction system in the total number of bacteria (RR 0.83, 95%CI 0.50 to 1.37), the number of SPP colony (RR 2.87, 95%CI 0.94 to 8.74) and the number of PSE colony (RR 1.46, 95%CI 0.76 to 2.77). There was no significant difference between the two groups in the duration of ventilation and length of hospital stay.
Conclusion 　Open or closed tracheal suction systems have similar effects on the rate of ventilator-associated pneumonia, case fatality, the number of SPP and PSE colonies, duration of ventilation and length of hospital stay. However, due to the differences in interventions and statistical power among studies included in this systematic review, further studies are needed to determine the effect of closed or open tracheal suction systems on these outcomes.

Citation： JIN Ling,WANG Haiyan,LI Bin. Closed versus Open Tracheal Suction Systems for Ventilator-associated Pneumonia in Adults: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(5): 346-351. doi: 10.7507/1672-2531.20080076 Copy

1.	Topeli A, Harmanci A, Cetinkaya Y, et al. Comparison of the effect of closed versus open endotracheal suction systems on the development of ventilator-associated pneumonia. J Hosp Infect, 2004, 58(1): 14-19.
2.	范关荣, 陈宗南, 葛文, 等. 二种吸痰方法的对比研究. 上海生物医学工程杂志, 2004, 25(4): 19-21.
3.	Blackwood B, Webb CH. Closed tracheal suctioning systems and infection control in the intensive care unit. J Hosp Infect, 1998, 39: 315-321.
4.	杨霞, 范学朋. 密闭式吸痰器在呼吸机治疗中的应用与护理. 中华护理杂志, 2005, 40(3): 196-198.
5.	Lorente L, Lecuona M, et al. Ventilator-associated pneumonia using a closed versus an open tracheal suction system. Crit Care Med, 2005, 33(1): 115-119.
6.	Stoller JK, Orens DK, Fatica C, et al. Weekly versus daily changes of in line suction cat heters: impact on rates of ventilator associated pneumonia and associated costs. Respir Care, 2003, 48(5): 494-499.
7.	Deppe SA, Kelly JW, Thoi LL, et al. 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, 1990, 18: 1389-1393.
8.	Adams DH, Hughes M, Elliott TS. Microbial colonization of closed system suction catheters used in liver transplant patients. Intensive Crit Care Nurs, 1997, 13(2): 72-76.
9.	Zeitoun SS, De Barros AL, Diccini S. A prospective, randomized study of ventilator-associated pneumonia in patients using a closed vs. open suction system. J Clin Nurs, 2003, 12(4): 484-489.
10.	Combes P, Fauvage B, Oleyer C. Nosocomial pneumonia in mechanically ventilated patients, a prospective randomized evaluation of the Stericath closed suctioning system. Intensive Care Med, 2000, 26(7): 878-882.
11.	Lee ES, Kim SH, Kim JS. Effects of a closed endotracheal suction system on oxygen saturation, ventilator- associated pneumonia, and nursing efficacy. Taehan Kanho Hakhoe Chi, 2004, 34(7): 1315-1325.
12.	Johnson KL, Kearney PA, Johnson SB, et al. Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med, 1994, 22: 658-666.
13.	Cordero L, Sananes M, Ayers LW. Comparison of a closed (Trach Care MAC) with an open endotracheal suction system in small premature infants. J Perinatol, 2000, 20: 151-156.
14.	Lee CK, Ng KS, Tan SG, et al. Effect of different endotracheal suctioning systems on cardiorespiratory parameters of ventilated patients. Ann Acad Med Singapore, 2001, 30: 239-244.
15.	Jongerden IP, Rovers MM, Grypdonck MH, et al. Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: A meta-analysis. Crit Care Med, 2007, 35(1): 260-270.
16.	王晓萍. 传统吸痰法与密闭式吸痰方式的临床比较. 中国实用护理杂志, 2004, 20(4): 41.
17.	尹利华, 王建荣, 张利岩. 密闭式吸痰研究进展. 南方护理学报, 2005, 12(4): 13-15.
18.	张兵, 王颖, 钟秀玲. 密闭式吸痰在机械通气患者中的临床应用. 现代护理杂志, 2006, 12(20): 1878-1879.
19.	刘妍, 何立平. 密闭式吸痰预防呼吸机相关性肺炎的观察效果. 护理研究杂志, 2006, 20(6): 1619-1620.
20.	王兰, 晁彦公, 李黎明, 等. 密闭式吸痰预防VAP的临床观察. 山东医药, 2006, 46(17): 50-51.
21.	康华. 密闭式吸痰管在机械通气病人气道护理中的应用. 现代护理杂志, 2006, 12(5): 471-473.
22.	田永明, 曾利辉, 廖燕. 密闭式吸痰的研究进展. 中华护理杂志, 2006, 41(11): 1037-1039.

1. Topeli A, Harmanci A, Cetinkaya Y, et al. Comparison of the effect of closed versus open endotracheal suction systems on the development of ventilator-associated pneumonia. J Hosp Infect, 2004, 58(1): 14-19.
2. 范关荣, 陈宗南, 葛文, 等. 二种吸痰方法的对比研究. 上海生物医学工程杂志, 2004, 25(4): 19-21.
3. Blackwood B, Webb CH. Closed tracheal suctioning systems and infection control in the intensive care unit. J Hosp Infect, 1998, 39: 315-321.
4. 杨霞, 范学朋. 密闭式吸痰器在呼吸机治疗中的应用与护理. 中华护理杂志, 2005, 40(3): 196-198.
5. Lorente L, Lecuona M, et al. Ventilator-associated pneumonia using a closed versus an open tracheal suction system. Crit Care Med, 2005, 33(1): 115-119.
6. Stoller JK, Orens DK, Fatica C, et al. Weekly versus daily changes of in line suction cat heters: impact on rates of ventilator associated pneumonia and associated costs. Respir Care, 2003, 48(5): 494-499.
7. Deppe SA, Kelly JW, Thoi LL, et al. 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, 1990, 18: 1389-1393.
8. Adams DH, Hughes M, Elliott TS. Microbial colonization of closed system suction catheters used in liver transplant patients. Intensive Crit Care Nurs, 1997, 13(2): 72-76.
9. Zeitoun SS, De Barros AL, Diccini S. A prospective, randomized study of ventilator-associated pneumonia in patients using a closed vs. open suction system. J Clin Nurs, 2003, 12(4): 484-489.
10. Combes P, Fauvage B, Oleyer C. Nosocomial pneumonia in mechanically ventilated patients, a prospective randomized evaluation of the Stericath closed suctioning system. Intensive Care Med, 2000, 26(7): 878-882.
11. Lee ES, Kim SH, Kim JS. Effects of a closed endotracheal suction system on oxygen saturation, ventilator- associated pneumonia, and nursing efficacy. Taehan Kanho Hakhoe Chi, 2004, 34(7): 1315-1325.
12. Johnson KL, Kearney PA, Johnson SB, et al. Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med, 1994, 22: 658-666.
13. Cordero L, Sananes M, Ayers LW. Comparison of a closed (Trach Care MAC) with an open endotracheal suction system in small premature infants. J Perinatol, 2000, 20: 151-156.
14. Lee CK, Ng KS, Tan SG, et al. Effect of different endotracheal suctioning systems on cardiorespiratory parameters of ventilated patients. Ann Acad Med Singapore, 2001, 30: 239-244.
15. Jongerden IP, Rovers MM, Grypdonck MH, et al. Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: A meta-analysis. Crit Care Med, 2007, 35(1): 260-270.
16. 王晓萍. 传统吸痰法与密闭式吸痰方式的临床比较. 中国实用护理杂志, 2004, 20(4): 41.
17. 尹利华, 王建荣, 张利岩. 密闭式吸痰研究进展. 南方护理学报, 2005, 12(4): 13-15.
18. 张兵, 王颖, 钟秀玲. 密闭式吸痰在机械通气患者中的临床应用. 现代护理杂志, 2006, 12(20): 1878-1879.
19. 刘妍, 何立平. 密闭式吸痰预防呼吸机相关性肺炎的观察效果. 护理研究杂志, 2006, 20(6): 1619-1620.
20. 王兰, 晁彦公, 李黎明, 等. 密闭式吸痰预防VAP的临床观察. 山东医药, 2006, 46(17): 50-51.
21. 康华. 密闭式吸痰管在机械通气病人气道护理中的应用. 现代护理杂志, 2006, 12(5): 471-473.
22. 田永明, 曾利辉, 廖燕. 密闭式吸痰的研究进展. 中华护理杂志, 2006, 41(11): 1037-1039.

Chinese Journal of Evidence-Based Medicine

Closed versus Open Tracheal Suction Systems for Ventilator-associated Pneumonia in Adults: A Systematic Review

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