Tuberc Respir Dis.  2008 Sep;65(3):198-206.

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

• Jung JW
• Choi EH
• Kim JH
• Seo HK
• Choi JY
• Choi JC
• Shin JW
• Park IW
• Choi BW
• Kim JY

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 another hinder 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 dollars for multiple-use, open suction, 28.27 dollars for single-use, open suction and 23.76 dollars 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.

Keyword

Closed suction; Cost; MRSA; Open suction; Ventilator-associated pneumonia

MeSH Terms

Catheters
Colon
Critical Illness
Humans
Incidence
Methicillin-Resistant Staphylococcus aureus
Pneumonia, Ventilator-Associated
Suction

Figure

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  Figure 1 Enrollment of patients for multiple-use, open suction, single-use, open suction and multiple-use, closed suction method. MV: mechanical ventilation.

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  Figure 2 Density of colonization by MRSA. MRSA colonized 7 patients in multiple-use, open suction group, 2 patients in single-use, open suction group and 4 patients in multiple-use, closed suction group. Seventy-nine patients discharged from multiple-use, open suction group during the study period and 88 from single-use, open suction group and 81 from multiple-use, closed suction group. The duration of ICU stay was 588 days, 593 days and 556 days, respectively. The density of colonization = colonization rate×10,000/days of ICU stay.

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  Figure 3 The incidence rate of VAP per 1,000 days of mechanical ventilation for multiple-use, open suction, single-use, open suction and multiple-use, closed suction method. VAP developed 4 cases in multiple-use, open suction group, 2 cases in single-use, open suction group and 2 cases in multiple-use, closed suction group. The duration of mechanical ventilation was 168 days, 172 days and 187 days, respectively.

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