Comparison of closed vs. open suction in prevention of VAP: A systematic review

Abstract

Ventilator associated events (VAEs) are one of the main sources of concern in critically ill patients due to the high frequency and mortality. We conducted this analysis to compare the effects of open endotracheal suctioning system with closed one on the incidences of VAEs in adult patients receiving mechanical ventilation. Methods: A comprehensive literature search was performed in PubMed, Scopus, Cochrane Library and hand searching bibliographies of retrieved articles. The search was confined to randomized controlled trials with human adults comparing closed tracheal suction systems (CTSS) versus open tracheal suction systems (OTSS) in prevention of ventilator associated pneumonia (VAP). Full text articles were used in order to extract the data. Data extraction was only started after completing the quality assessment. Results: The search resulted in 59 publications. Among them, 10 were identified as eligible for meta-analysis. There was a significant increase in incidence of VAP when using OTSS compared to CTSS, so that OCSS increased the incidence of VAP by 57% (OR 1.57, 95% CI 1.063-2.32, P=0.02).