Archives of Anesthesiology and Critical Care 2016. 2(2):193-196.

Evaluation of the Effect of Open and Closed Tracheal Suction on the Incidence of Ventilator Associated Pneumonia in Patients Admitted in the Intensive Care Unit
Nasim Alipour, Nahid Manouchehrian, Mehdi Sanatkar, Hassan Mohammadi Poor Anvari, Mohammad Sadegh Sanie Jahromi


Background: Nosocomial pneumonia is a prevalent complication in patients admitted to intensive care units (ICU). Endotracheal suction is used in cleaning the airways of secretions in patients under mechanical ventilation. Performing suction accurately is of great importance to prevent ventilation associated pneumonia. The purpose of this study was to compare the effect of open versus closed tracheal suction on the incidence of VAP.

Methods: This was a clinical trial study performed on 86 intubated patients in ICU. Patients of control group (n=43) underwent conventional open suction and case group (n=43) closed suction. After 72 hours, patients were assessed regarding VAP using clinical pulmonary infection score (CPIS).

Results: There was no significant difference regarding age (p=0.15) and gender (p=0.33) between the two groups. The incidence of ventilator associated pneumonia was significantly lower in closed method compared to the open method (p=0.016).

Conclusion: Closed tracheal suction compared to the open method was associated with lower incidence of VAP in patients of ICU.


ventilation associated pneumonia; intensive care unit; nosocomial pneumonia

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Longo D, Kasper D,Jemson L, Antoni F. Harrison's Principles of Internal Medicine. Rahmatian ghadikalani M ,Translator.2th ed. Andishe Rafie:Tehran;2010. P125-139

Vincent JL, Abraham E, Moore F, Fink M, Kochanek PM. Critical care. 6th ed. Amsterdam: Elsevier Publishers; 2011. P 464-480.

Dezfulian C, Shojania K, Collard HR, Kim HM, Matthay MA, Saint S. Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis. Am J Med. 2005; 118(1): 11-18.

Gadani H, Vyas A, Kumar Kar A. A study of ventilator-associated pneumonia: Incidence, outcome, risk factors and measures to be taken for prevention. Indian J Anaesth. 2010; 54(6):535-40.

Vanhems P, Bénet T, Voirin N, Januel JM, Lepape A, Allaouchiche B, et al. Early-onset ventilator-associated pneumonia incidence in intensive care units: a surveillance-based study. BMC Infect Dis. 2011; 11: 236.

Kandeel N, Tantawy N. Current nursing practice for prevention of ventilator associated pneumonia in ICUs. Life Science Journal. 2012; 9(3):966-73.

Subirana M, Sola I, Benito S. Closed suctioning systems versus open suctioning system. Lancet. 2008; 45(2):127-130.

Juneja D, Javeri Y, Singh O, Nasa P, Pandey R, Uniyal B. Comparing influence of intermittent subglottic secretions drainagewith/without closed suction system on the incidence of Ventilator-associated Pneumonia. Indian J Crit Care Med. 2011; 15(3):168-72.

Seto W. H,Cheng C.F, Ching T.Y, Ho Pak L, Kwan K. C, Leung L.M, et al. Recommendations on Prevention of Ventilator-associated Pneumonia. Scientific Committee on Infection Control Secretariat Centre for Health Protection. 2010. Available:[Accessed:December 18, 2012].

Mandell G.L, Douglas R, Benntt J.E. Principles and practices of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier, 2010. P.1750-1765.

Jaimes F, De La Rosa G, Gómez E, Múnera P, Ramírez J, Castrillón S. Incidence and risk factors for ventilator-associated pneumonia in a developing country: Where is the difference? Respir Med. 2007; 101(4):762-7.

Chandrakanth C, Anushree A, Vinod A. Incidence of ventilator associated pneumonia. International Journal of Medical and Clinical Research. 2010; 1(2):11-13.

Teresa A, Volsko M. Prevention of ventilator associated pneumonia. Clinical Foundations. 2008; 18(2):69-71.

Pagotto IM, Oliveira LR, Araújo FC, Carvalho NA, Chiavone P. Comparison between open and closed suction systems:A systematic review. Rev Bras Ter Intensiva. 2008; 20(4): 331-8.

Branson RD. Secretion Management in the Mechanically Ventilated Patient. Respir Care. 2007; 52(10):1328-42.

Jongerden IP, Rovers MM, Grypdonck MH, Bonten MJ. Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: A meta-analysis. Crit Care Med. 2007; 35(1):260-70.

Phipps WJ, Monaham FD, Sand's JK. Medical surgical nursing; health and illness prospective. 7th ed. Philadelphia, Mosby, 2011. P. 454-459.

Heyland D, Mount Sinai. Hospital critical care research - current studies VAP study. Am J Respir Crit Care Med 1999; 159(4): 1249-1256.

Fox MY. Toward a Zero VAP rate personal and team approaches in the ICU. Crit Care Nurs Q. 2006; 29(2):108-14.

Woo Jung J, Hee Choi E, Hee Kim J, Kyung Seo J, Yeon Choi J. Comparison of a Closed with an Open Endotracheal Suction: Costs and the Incidence of Ventilator-associated Pneumonia.Tuberculosis and Respiratory Diseases. 2008; 65(3):198-206.

Ebrahimi fakhar H, Rezaei K, Kohestani H. Closed suction effect of pulmonary secretions of Ventilator-associated Pneumonia. Scientific Journal of Kurdistan University of Medical Sciences. 2010; 15(2):79-87. [in Persian]

David D, Samuel P, David T, Keshava SN, Irodi A, Peter JV. An open-labelled randomized controlled trial comparing costs and clinical outcomes of open endotracheal suctioning with closed endotracheal suctioning in mechanically ventilated medical intensive care patients. J Crit Care. 2011; 26(5):482-8.

Powers J. Managing VAP effectively to optimize outcomes and costs. Nurs Manage. 2006; 37(11):48A-48F;

Branson RD. The ventilator circuit and ventilator-associated pneumonia. Respir Care. 2005; 50(6): 774-85.

Combes P, Fauvage B, Oleyer C. Nosocomial pneumonia in mechanically ventilated patients: a prospective randomised evaluation of the Stericath closed suctioning system. Intensive Care Med. 2000; 26(7):878-82.

Morrow BM, Mowzer R, Pitcher R, Argent AC. Investigation into the effect of closed-system suctioning on the frequency of pediatric ventilator-associated pneumonia in a developing country. Pediatr Crit Care Med. 2012; 13(1): 25-32.

Niël-Weise BS, Snoeren RL, van den Broek PJ. Policies for Endotracheal Suctioning of Patients Receiving Mechanical Ventilation: A Systematic Review of Randomized Controlled Trials. Infect Control Hosp Epidemiol. 2007; 28(5):531-6.

Ruben D Joel M, John M. Endotracheal Suctioning of Mechanically Ventilated Patients With Artificial Airways 2010(American Association for Respiratory Care Clinical Practice Guidelines Steering Committee). Respir care. 2010; 55(6):758-64.


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