Efficacy of closed and open tracheal suction systems for prevention of ventilator-associated pneumonia: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WONG Waiman ^1,2 ,  WANG Yan ¹

1. Macao Polytechnic Institute, Macau 999078, P.R.China;
2. Hospital Infection Control Committee, Centro Hospitalar Conde de São Januário, Macau 999078, P.R.China;

Corresponding author：

WANG Yan, Email: ywang@ipm.edu.mo

Keywords：

Closed tracheal suction system; Open tracheal suction system; Ventilator-associated pneumonia; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.202006212

Video：

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Objective To systematically review the efficacy of closed and open tracheal suction system on the prevention of ventilator-associated pneumonia.Methods The Cochrane Library, CNKI, WanFang Data, Airiti Library, PubMed, CINAHL and Proquest databases were electronically searched to collect randomized controlled trials (RCTs) on closed and open tracheal suction system on the prevention of ventilator-associated pneumonia. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.Results A total of 11 RCTs involving 1 187 patients were included. The results of meta-analysis showed that compared with open tracheal suction system, closed tracheal suction system was associated with a reduced incidence of ventilator-associated pneumonia (RR=0.55, 95%CI 0.44 to 0.67, P<0.000 01), late-onset ventilator-associated pneumonia (RR=0.47, 95%CI 0.28 to 0.80, P=0.005), length of stay in intensive care unit (MD=−0.85, 95%CI −1.66 to −0.04, P=0.04) and rate of microbial colonization (RR=0.69, 95%CI 0.56 to 0.86, P=0.000 9). However, there were no significant differences between two groups in time to ventilator-associated pneumonia development (MD=0.96, 95%CI −0.21 to 2.12, P=0.11), length of mechanical ventilation (MD=−2.24, 95%CI −4.54 to 0.06, P=0.06), and rate of mortality (RR=0.88, 95%CI 0.73 to 1.05, P=0.15).Conclusions Current evidence shows that compared with open tracheal suction system, closed tracheal suction system can reduce the incidence of ventilator-associated pneumonia and late-onset ventilator-associated pneumonia, shorten the hospital stay in intensive care unit, and reduce rate of microbial colonization. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： WONG Waiman, WANG Yan. Efficacy of closed and open tracheal suction systems for prevention of ventilator-associated pneumonia: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(1): 21-27. doi: 10.7507/1672-2531.202006212 Copy

1.	Centers for Disease Control and Prevention. Pneumonia (Ventilator-associated [VAP] and non-ventilator-associated Pneumonia [PNEU]) event. National Healthcare Safety Network (NHSN) patient safety component manual. Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/6pscvapcurrent.pdf.
2.	Ding C, Zhang Y, Yang Z, et al. Incidence, temporal trend and factors associated with ventilator-associated pneumonia in mainland China: a systematic review and meta-analysis. BMC Infect Dis, 2017, 17(1): 468.
3.	Magill SS, O'Leary E, Janelle SJ, et al. Changes in prevalence of health care-associated infections in U. S. hospitals. N Engl J Med, 2018, 379(18): 1732-1744.
4.	Klompas M, Branson R, Eichenwald EC, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol, 2014, 35(8): 915-936.
5.	Melsen WG, Rovers MM, Groenwold RH, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis, 2013, 13(8): 665-671.
6.	Mietto C, Pinciroli R, Patel N, et al. Ventilator associated pneumonia: evolving definitions and preventive strategies. Respir Care, 2013, 58(6): 990-1007.
7.	Azam F, Alireza K, Gholamreza M, et al. Open and closed endotracheal suctioning and arterial blood gas values: a single-blind crossover randomized clinical trial. Crit Care Res Pract, 2015: 470842.
8.	陈佩卿, 徐伟桦, 沙炜惠, 等. 置放气管内管病人使用密闭式抽痰或开放式抽痰对生理参数, 环境菌落数及疼痛之成效探讨. 领导护理, 2018, 19(2): 24-35.
9.	Vijai MN, Ravi PR, Setlur R, et al. Efficacy of intermittent sub-glottic suctioning in prevention of ventilator-associated pneumonia- a preliminary study of 100 patients. Indian J Anaesth, 2016, 60(5): 319-324.
10.	Solà I, Benito S. Closed tracheal suction systems versus open tracheal suction systems for mechanically ventilated adult patients. Cochrane Database Syst Rev, 2007, (4): CD004581.
11.	田苗, 张豪, 左红霞, 等. 国内外不同吸痰方式对预防呼吸机相关性肺炎的 Meta 分析. 湖北医药学院学报, 2018, 37(6): 504-510.
12.	中华医学会重症医学分会. 呼吸机相关性肺炎诊断, 预防和治疗指南(2013). 中华内科杂志, 2013, 52(6): 524-543.
13.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration, 2019. Available at: http://www.cochrane-handbook.org.
14.	Ardehali SH, Fatemi A, Rezaei SF, et al. The effects of open and closed suction methods on occurrence of ventilator associated pneumonia: a comparative study. Arch Acad Emerg Med, 2020, 8(1): e8.
15.	张宏. 密闭式吸痰对 VAP 的预防作用研究. 现代医药卫生, 2019, 35(17): 2684-2686.
16.	Elmansoury A, Said H. Closed suction system versus open suction. Egypt J Chest Dis Tuberc, 2017, 66(3): 509-515.
17.	Alipour N, Manouchehrian N, Sanatkar M, et al. 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. Arch Anesth Crit Care, 2016, 2(2): 193-196.
18.	Hamishekar H, Shadvar K, Taghizadeh M, et al. Ventilator-associated pneumonia in patients admitted to intensive care units, using open or closed endotracheal suctioning. Anesth Pain Med, 2014, 4(5): e21649.
19.	迟红丽, 林淑梅, 翟旭杰. 人工鼻联合密闭式吸痰管预防呼吸机相关性肺炎的疗效. 中国老年学杂志, 2013, 33(18): 4629-4631.
20.	余栋栽, 李倩文, 谭家香, 等. 持续气囊上吸引联合密闭式吸痰预防呼吸机相关性肺炎的临床研究. 中外医疗, 2013, 32(14): 35-36.
21.	David D, Samuel P, David T, et al. 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): 482-488.
22.	Cha KS, Park HR. [Endotracheal colonization and ventilator-associated pneumonia in mechanically ventilated patients according to type of endotracheal suction system]. J Korean Acad Nurs, 2011, 41(2): 175-181.
23.	吴伟英. 两种不同吸痰方式对呼吸机相关性肺炎应用效果评价. 现代预防医学, 2011, 38(9): 1778-1779.
24.	吴瑶, 行雯婧, 陈欣扬, 等. 两种吸痰方式预防心胸外科术后机械通气患者呼吸道感染的效果. 华西医学, 2011, 26(8): 1226-1229.
25.	于海容, 王婧婷, 黄婷婷, 等. 机械通气患者密闭式与开放式吸痰效果比较的系统评价. 解放军护理杂志, 2014, 31(14): 1-6.
26.	Kuriyama A, Umakoshi N, Fujinaga J, et al. Impact of closed versus open tracheal suctioning systems for mechanically ventilated adults: a systematic review and meta-analysis. Intensive Care Med, 2015, 41(3): 402-411.
27.	董亮, 于涛, 杨毅, 等. 封闭式和开放式吸痰系统临床效果与安全性评价的Meta分析. 中华内科杂志, 2012, 51(10): 763-768.
28.	Afshari A, Safari M, Oshvandi K, et al. The effect of the open and closed system suctions on cardiopulmonary parameters: time and costs in patients under mechanical ventilation. Nurs Midwifery Stud, 2014, 3(2): e14097.
29.	Philippart F, Gaudry S, Quinquis L, et al. Randomized intubation with polyurethane or conical cuffs to prevent pneumonia in ventilated patients. Am J Respir Crit Care Med, 2015, 191(6): 637-645.
30.	Nseir S, Ader F, Lubret R, et al. Pathophysiology of airway colonization in critically ill COPD patient. Curr Drug Targets, 2011, 12(4): 514-520.
31.	Nseir S, Zerimech F, Jaillette E, et al. Microaspiration in intubated critically ill patients: diagnosis and prevention. Infect Disord Drug Targets, 2011, 11(4): 413-423.
32.	Diaconu O, Siriopol I, Poloșanu LI, et al. Endotracheal tube biofilm and its impact on the pathogenesis of ventilator-associated pneumonia. J Crit Care Med (Targu Mures), 2018, 4(2): 50-55.
33.	万国华. 呼吸治疗技术与医院空气质量. 长庚科技学刊, 2014, (21): 1-12.
34.	Cook TM, El-Boghdadly K, McGuire B, et al. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the difficult airway society, the association of anaesthetists the intensive care society, the faculty of intensive care medicine and the royal college of anaesthetists. Anaesthesia, 2020, 75(6): 785-799.
35.	Centers for Disease Control and Prevention. Ventilator-Associated Event (VAE). National Healthcare Safety Network (NHSN) patient safety component manual. Available at: https://www.cdc.gov/nhsn/PDFs/pscManual/10-VAE_FINAL.pdf.
36.	康德英, 洪旗. 如何评价 Meta-分析的统计分析结果. 中国循证医学, 2001, 1(2): 106-108.

1. Centers for Disease Control and Prevention. Pneumonia (Ventilator-associated [VAP] and non-ventilator-associated Pneumonia [PNEU]) event. National Healthcare Safety Network (NHSN) patient safety component manual. Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/6pscvapcurrent.pdf.
2. Ding C, Zhang Y, Yang Z, et al. Incidence, temporal trend and factors associated with ventilator-associated pneumonia in mainland China: a systematic review and meta-analysis. BMC Infect Dis, 2017, 17(1): 468.
3. Magill SS, O'Leary E, Janelle SJ, et al. Changes in prevalence of health care-associated infections in U. S. hospitals. N Engl J Med, 2018, 379(18): 1732-1744.
4. Klompas M, Branson R, Eichenwald EC, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol, 2014, 35(8): 915-936.
5. Melsen WG, Rovers MM, Groenwold RH, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis, 2013, 13(8): 665-671.
6. Mietto C, Pinciroli R, Patel N, et al. Ventilator associated pneumonia: evolving definitions and preventive strategies. Respir Care, 2013, 58(6): 990-1007.
7. Azam F, Alireza K, Gholamreza M, et al. Open and closed endotracheal suctioning and arterial blood gas values: a single-blind crossover randomized clinical trial. Crit Care Res Pract, 2015: 470842.
8. 陈佩卿, 徐伟桦, 沙炜惠, 等. 置放气管内管病人使用密闭式抽痰或开放式抽痰对生理参数, 环境菌落数及疼痛之成效探讨. 领导护理, 2018, 19(2): 24-35.
9. Vijai MN, Ravi PR, Setlur R, et al. Efficacy of intermittent sub-glottic suctioning in prevention of ventilator-associated pneumonia- a preliminary study of 100 patients. Indian J Anaesth, 2016, 60(5): 319-324.
10. Solà I, Benito S. Closed tracheal suction systems versus open tracheal suction systems for mechanically ventilated adult patients. Cochrane Database Syst Rev, 2007, (4): CD004581.
11. 田苗, 张豪, 左红霞, 等. 国内外不同吸痰方式对预防呼吸机相关性肺炎的 Meta 分析. 湖北医药学院学报, 2018, 37(6): 504-510.
12. 中华医学会重症医学分会. 呼吸机相关性肺炎诊断, 预防和治疗指南(2013). 中华内科杂志, 2013, 52(6): 524-543.
13. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration, 2019. Available at: http://www.cochrane-handbook.org.
14. Ardehali SH, Fatemi A, Rezaei SF, et al. The effects of open and closed suction methods on occurrence of ventilator associated pneumonia: a comparative study. Arch Acad Emerg Med, 2020, 8(1): e8.
15. 张宏. 密闭式吸痰对 VAP 的预防作用研究. 现代医药卫生, 2019, 35(17): 2684-2686.
16. Elmansoury A, Said H. Closed suction system versus open suction. Egypt J Chest Dis Tuberc, 2017, 66(3): 509-515.
17. Alipour N, Manouchehrian N, Sanatkar M, et al. 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. Arch Anesth Crit Care, 2016, 2(2): 193-196.
18. Hamishekar H, Shadvar K, Taghizadeh M, et al. Ventilator-associated pneumonia in patients admitted to intensive care units, using open or closed endotracheal suctioning. Anesth Pain Med, 2014, 4(5): e21649.
19. 迟红丽, 林淑梅, 翟旭杰. 人工鼻联合密闭式吸痰管预防呼吸机相关性肺炎的疗效. 中国老年学杂志, 2013, 33(18): 4629-4631.
20. 余栋栽, 李倩文, 谭家香, 等. 持续气囊上吸引联合密闭式吸痰预防呼吸机相关性肺炎的临床研究. 中外医疗, 2013, 32(14): 35-36.
21. David D, Samuel P, David T, et al. 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): 482-488.
22. Cha KS, Park HR. [Endotracheal colonization and ventilator-associated pneumonia in mechanically ventilated patients according to type of endotracheal suction system]. J Korean Acad Nurs, 2011, 41(2): 175-181.
23. 吴伟英. 两种不同吸痰方式对呼吸机相关性肺炎应用效果评价. 现代预防医学, 2011, 38(9): 1778-1779.
24. 吴瑶, 行雯婧, 陈欣扬, 等. 两种吸痰方式预防心胸外科术后机械通气患者呼吸道感染的效果. 华西医学, 2011, 26(8): 1226-1229.
25. 于海容, 王婧婷, 黄婷婷, 等. 机械通气患者密闭式与开放式吸痰效果比较的系统评价. 解放军护理杂志, 2014, 31(14): 1-6.
26. Kuriyama A, Umakoshi N, Fujinaga J, et al. Impact of closed versus open tracheal suctioning systems for mechanically ventilated adults: a systematic review and meta-analysis. Intensive Care Med, 2015, 41(3): 402-411.
27. 董亮, 于涛, 杨毅, 等. 封闭式和开放式吸痰系统临床效果与安全性评价的Meta分析. 中华内科杂志, 2012, 51(10): 763-768.
28. Afshari A, Safari M, Oshvandi K, et al. The effect of the open and closed system suctions on cardiopulmonary parameters: time and costs in patients under mechanical ventilation. Nurs Midwifery Stud, 2014, 3(2): e14097.
29. Philippart F, Gaudry S, Quinquis L, et al. Randomized intubation with polyurethane or conical cuffs to prevent pneumonia in ventilated patients. Am J Respir Crit Care Med, 2015, 191(6): 637-645.
30. Nseir S, Ader F, Lubret R, et al. Pathophysiology of airway colonization in critically ill COPD patient. Curr Drug Targets, 2011, 12(4): 514-520.
31. Nseir S, Zerimech F, Jaillette E, et al. Microaspiration in intubated critically ill patients: diagnosis and prevention. Infect Disord Drug Targets, 2011, 11(4): 413-423.
32. Diaconu O, Siriopol I, Poloșanu LI, et al. Endotracheal tube biofilm and its impact on the pathogenesis of ventilator-associated pneumonia. J Crit Care Med (Targu Mures), 2018, 4(2): 50-55.
33. 万国华. 呼吸治疗技术与医院空气质量. 长庚科技学刊, 2014, (21): 1-12.
34. Cook TM, El-Boghdadly K, McGuire B, et al. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the difficult airway society, the association of anaesthetists the intensive care society, the faculty of intensive care medicine and the royal college of anaesthetists. Anaesthesia, 2020, 75(6): 785-799.
35. Centers for Disease Control and Prevention. Ventilator-Associated Event (VAE). National Healthcare Safety Network (NHSN) patient safety component manual. Available at: https://www.cdc.gov/nhsn/PDFs/pscManual/10-VAE_FINAL.pdf.
36. 康德英, 洪旗. 如何评价 Meta-分析的统计分析结果. 中国循证医学, 2001, 1(2): 106-108.

Chinese Journal of Evidence-Based Medicine

Efficacy of closed and open tracheal suction systems for prevention of ventilator-associated pneumonia: a meta-analysis

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