TABLE 2.
Summary of randomized studies on open (OS) and closed suctioning (CS)
| Author (reference), study design | Description of groups and interventions | Outcome measures | Summary of main results |
|---|---|---|---|
| Bourgault et al (7), RCO | Sample: Positive pressure MV patients, PEEP ≤7.5 cm H2O (n=18)
Intervention 1: OS Intervention 2: CS, 2 suction passes, 15 s/pass, 30 s on MV between passes, 100% O2 for 1 min (20 breaths) before first pass, 120 mmHg pressure |
PaO2 Heart rate variability Baroreflex sensitivity |
No significant difference between interventions for any outcome measure |
| Maggiori et al (8), RCO | Sample: Patients in ICU with ARDS/ALI requiring MV (n=18)
Intervention 1: suction after disconnection from ventilator (DISCONNECT) Intervention 2: suction through swivel adaptor of catheter mount (SWIVEL) Intervention 3: CS Intervention 4: suction during SWIVEL with PS Intervention 5: CS with PS |
EELV
Alveolar recruitment SpO2 |
Greater loss of EELV after DISCONNECT (P<0.001)
Alveolar recruitment decreased after DISCONNECT and SWIVEL (P<0.01) and increased after SWIVEL and CS with PS (P<0.01) Decrease in SpO2 was greater after DISCONNECT (P<0.01) |
| Cereda et al (20), RCO | Sample: Patients in ICU with ALI requiring MV. PEEP ≥5 cmH2O (range 5–15), with VCV and pharmaceutically paralyzed with hourly boluses (n=10)
Intervention 1: OS Intervention 2, CS: Alternate randomized suction (OS, CS and CS, OS) with 20 min recovery between suction manoeuvres |
Lung volume
SpO2 Airway pressure Arterial gases Heart rate Arterial pressure |
Greater loss of lung volume (P<0.010) and decrease in SpO2 (P<0.05) with intervention 1 |
| Combes et al (21), RCT | Sample: Neurosurgical patients requiring MV (n=104)
Group 1 OS (n=54): Suction passes in a single suctioning event used the same catheter following cleansing with sterile solution Group 2 (n=50): CS For both groups: clean gloves used, suctioned every 2 h, if second suction required, catheter cleaned with sterile solution |
Incidence of VAP
LOS in ICU |
Risk of VAP was 3.5 times higher in group 1 versus group 2 (P=0.05) |
| Lorente et al (22), RCT | Sample: Patients in ICU requiring >24 h continuous MV (n=443)
Group 1 (n=233): OS Group 2 (n=210): CS, both groups received identical strict protocols to minimize risk of VAP Barrier measures for group 1 only |
Incidence of VAP
Microorganisms isolated in VAP Duration of days on MV Cost |
No significant difference for incidence of VAP, microorganisms isolated and days on MV
Group 2 had greater costs (P<0.001) |
| Lorente et al (23), RCT | Sample: Patients in ICU requiring MV (n=457)
Group 1 (n=236): OS, aseptic technique, one catheter for each aspiration Group 2 (n=221): CS, changed catheter only when necessary (mechanical failure or soiling), used universal precautions Both groups received identical strict protocols to minimize risk of VAP. Barrier measures for group 1 only |
Incidence of VAP
Incidence of VAP/1000 days of MV Cost |
No significant difference in incidence of VAP, or incidence of VAP/1000 days of MV
For MV <4 days, cost for group 2 greater than for group 1 (P<0.001). For MV >4 days, cost for group 2 less than for group 1 (P<0.001) |
| Rabitsch et al (24), RCT | System: Patients in ICU requiring MV ≥3 days (n=24)
Group 1 (n=12): OS, using a new catheter for each pass Group 2 (n=12): CS, catheter replaced every 24 h |
Bronchial contamination with gastric juices (cross-contamination)
Incidence of VAP SpO2 |
Group 1 had more cross-contamination and incidence of VAP (P=0.037) Decrease in SpO2 was greater in group 1 (P<0.001)
No significant cross-contamination in group 2 |
| Topeli et al (25), RCT | Sample: Patients in MICU requiring MV >24 h (n=78)
Group 1 (n=37): OS performed through a T tube without removing patient from ventilator, using aseptic technique Group 2 (n=41): CS used repeatedly, changed when grossly contaminated or integrity of catheter was compromised |
Incidence of VAP
Mortality LOS (in ICU) Duration of MV Colonization of MV circuit |
No significant difference in VAP, mortality, LOS (in ICU) or duration of MV
Colonization of MV circuit was greater in group 2 (P<0.01) |
| Lasocki et al (27), RCO | Sample: Patients in ICU with ALI requiring MV (n=18)
Part 1 (n=9): Preoxygenation, 100% O2 for 15 min Intervention 1: OS, −200 cmH2O for 20 s Intervention 2: CS, catheter inserted in swivel adaptor, −200 cmH2O for 20 s followed by recruitment manoeuvre (20 breaths at 2×VT) Part 2 (n=9): Intervention 1: CS at −200 cmH2O Intervention 2: CS at − 400 cmH2O For both interventions, suction followed by recruitment manoeuvre (20 breaths at 2 × VT) |
PaO2 Wet aspirate mass |
Part 1: Decrease in PaO2 was greater with intervention 1 (P=0.015).
Wet aspirate mass greater with intervention 1 at suction pressure of −200 cmH2O (P=0.03) Part 2: No significant differences in PaO2 between interventions. Increase in wet aspirate mass for intervention 2 (P=0.02). |
| Lee et al (28), RCO | Sample: Patients in SICU requiring MV (n=14)
Intervention 1: OS Intervention 2: CS For both interventions: 60 s hyperoxygenation, 10 s suction, 30 s hyperoxygenation, 10 s suction, 30 s hyperoxgygenation |
Heart rate
MAP SpO2 ECG rhythm |
Intervention 1 elicited higher heart rate and MAP (P ≤ 0.05) and lower SpO2 (P≤ 0.01) during and after suctioning.
Intervention 1 had a greater incidence of arrhythmias (P≤0.05). NOTE: Query clinical significance of changes |
| Darvas and Hawkins (29), RCT | Sample: Patients in ICU requiring MV (n=101)
Group 1 (n=53): CS (catheter replaced every 24 h) Group 2 (n=48): CS (catheter replaced every 48 h) ‘Standard suction procedure’ with sterile saline rinse for CS |
Incidence of VAP
Duration of MV LOS in ICU Mortality |
No significant difference between groups for any outcome measure. |
| Quirke (30), RCT | System: Patients in ICU requiring MV for > 48 h, (n=73)
Group 1 (n=34): CS (catheter replaced every 24 h) Group 2 (n=39): CS (catheter replaced every 48 h) CS catheter tips were examined for colonization at 24 h and 48 h postintubation Sputum samples were taken at 24 h and 48 h |
Colonization of sputum
Colonization of suction catheter tips LOS in ICU Mortality |
No significant difference in number of colonized suction tips, or in number of sputum colonies at 48 h
In colonized tips, greater number of colonies for group 2 (P<0.05) No significant difference between groups in LOS in ICU or mortality |
ALI Acute lung injury; ARDS Acute respiratory distress syndrome; BP Blood pressure; CS Closed suctioning; ECG Electrocardiogram; EELV End-expiratory lung volume; ICU Intensive care unit; LOS Length of stay; MAP Mean arterial pressure; MICU Medical intensive care unit; MV Mechanical ventilation; OS Open suctioning; PaO2 Arterial pressure of oxygen; PEEP Positive end-expiratory pressure; PS Pressure support; RCO Randomized crossover study; RCT Randomized controlled trial; SaO2 Arterial oxygen saturation; SICU Surgical intensive care unit; SpO2 Oxygen saturation by pulse oximetry; VAP Ventilator-associated pneumonia; VCV Volume control ventilation; VT Tidal volume