바로가기메뉴

본문 바로가기 주메뉴 바로가기

Comparison of a Closed with an Open Endotracheal Suction: Costs and the Incidence of Ventilator-associated Pneumonia

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2008, v.65 no.3, pp.198-206










  • Downloaded
  • Viewed

Abstract

Background: Tracheobronchial suctioning using the closed suctioning system has physiological benefits for critically ill patients. Despite these benefits, there are concerns about increased colonization of tracheobronchial tree by pathogenic organisms. The cost is anotherhinder to the introduction of closed suction system. The aim of this study was to evaluate the incidence of colonization and ventilator associated pneumonia and the cost-effectiveness of closed suction compared with open suction. Methods: During separated one month period, patients admitted MICU were cared by multiple-use, open suction, single-use, open suction and multiple-use, closed suction method, consecutively. Costs, colonization of tracheobronchial tree by MRSA and the incidence of ventilator-associated pneumonia (VAP) were analyzed. Results: One-hundred and six patients were enrolled. Twenty patients were treated with multiple-use, open suction, while 42 and 44 patients were cared with single- use, open catheter and multiple-use, closed catheter, respectively. Colonization by MRSA and the incidence of VAP were not different among three ways of suctioning. The overall costs per patient per day for suctioning were $10.58 for multiple-use, open suction, $28.27 for single-use, open suction and $23.76 for multiple- use, closed suction. Conclusion: Multiple-use, closed suctioning, when suction catheters were changed every 48 hrs, has the similar incidence of colonization of MRSA and occurrence of VAP and is a cost-efficient way of endotracheal suction.

keywords
Closed suction, Cost, MRSA, Open suction, Ventilator-associated pneumonia

Reference

1.

1. Craig CK, Benson MS, Pierson DJ. Prevention of arterial oxygen desaturation during closed airway endotracheal suctioning: effect of ventilator mode. Respir Care 1984; 29:1013-8.

2.

2. Skelley BF, Deeren SM, Powaser MM. The effectiveness of two preoxygenation methods to prevent endotracheal suction-induced hypoxemia. Heart Lung 1980;9:316-23.

3.

3. Walsh JM, Vanderwarf C, Hoscheit D, Fahey PJ. Unsuspected hemodynamic alterations during endotracheal suctioning. Chest 1989;95:162-5.

4.

4. Clark AP, Winslow EH, Tyler DO, White KM. Effects of endotracheal suctioning on mixed venous oxygen saturation and heart rate in critically ill adults. Heart Lung 1990;19:552-7.

5.

5. Shim C, Fine N, Fernandez R, Williams MH Jr. Cardiac arrhythmias resulting from tracheal suctioning. Ann Intern Med 1969;71:1149-53.

6.

6. Durand M, Sangha B, Cabal LA, Hoppenbrouwers T, Hodgman JE. Cardiopulmonary and intracranial pressure changes related to endotracheal suctioning in preterm infants. Crit Care Med 1989;17:506-10.

7.

7. Choong K, Chatrkaw P, Frndova H, Cox PN. Comparison of loss in lung volume with open versus in-line catheter endotracheal suctioning. Crit Care Med 2003;4:69-73.

8.

8. Cobley M, Atkins M, Jones PL. Environmental contamination during tracheal suction: a comparison of disposable conventional catheters with a multiple-use closed system device. Anaesthesia 1991;46:957-61.

9.

9. Bodai BI. A means of suctioning without cardiopulmonary depression. Heart Lung 1982;11:172-6.

10.

10. 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;20:151-6.

11.

11. 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;26:878-82.

12.

12. Deppe SA, Kelly JW, Thoi LL, Chudy JH, Longfield RN, Ducey JP, 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;18:1389-93.

13.

13. Canadian Critical Care Trials Group. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med 2006;355:2619-30.

14.

14. Kollef MH. The prevention of ventilator-associated pneumonia. N Engl J Med 1999;340:627-34.

15.

15. Kerem E, Yatsiv I, Goitein KJ. Effect of endotracheal suctioning on arterial blood gases in children. Intensive Care Med 1990;16:95-9.

16.

16. DePew C, Moseley M, Clark EG, Morales CC. Open versus closed-system endotracheal suctioning: as cost comparison. Crit Care Nurse 1994;14:94-100.

17.

17. Lorente L, Lecuona M, Jimenez A, Mora ML, Sierra A. Tracheal suction by closed system without daily change versus open system. Intensive Care Med 2006;32:538-44.

18.

18. Sole ML, Poalillo FE, Byers JF, Ludy JE. Bacterial growth in secretions and on suctioning equipment of orally in tubated patients: a pilot study. Am J Crit Care 2002;11:141-9.

19.

19. Ritz R, Scott LR, Coyle MB, Pierson DJ. Contamination of a multiple-use suction catheter in a closed-circuit system compared to contamination of a disposable, single-use suction catheter. Respir Care 1986;31:1086-91.

20.

20. Rello J, Quintana E, Ausina V, Castella J, Luquin M, Net A, et al. Incidence, etiology and outcome of nosocomial pneumonia in mechanically ventilated patients. Chest 1991;100:439-44.

21.

21. Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Darne C, et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation: prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 1989;139:877-84.

22.

22. Johnson KL, Kearney PA, Johnson SB, Niblett JB, MacMillan NL, McClain RE. Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med 1994;22:658-66.

Tuberculosis & Respiratory Diseases