Open versus closed suctioning of artificial airways in critically ill adult patients: An evidence review

Abstract

Suctioning of a tracheal tube is a frequent and integral activity to airway management in adult intensive care. Airway suctioning can have deleterious effects on physiological function. Both Open Suction Systems (OSS) and Closed Suction Systems (CSS) have been used in critical care settings. The objective of this review was to determine which system (OSS or CSS) has an evidence based advantage for clinical practice. A systematic literature review was conducted. Medline, Ovid SP and PubMed databases were searched using the keywords suction, critical/intensive care, open suction system and closed suction system. Search filters were: human, adult, english language and published between 2006 and June 2012. Two reviewers extracted data using a standardised tool which incorporated the Scottish Intercollegiate Guideline Network quality criteria. Eleven articles met the inclusion criteria, two meta-analysis, four systematic reviews, two randomised control trials, one interrupted time series, an observational study, and a convenience sample review. The evidence favoured OSS for tube colonisation and costs for <4 days ventilation; whereas CSS was better regarding end expiratory lung volume losses and for ventilation costs >4 days. There was no difference between systems for oxygenation, haemodynamics, sputum clearance, iatrogenic pneumonia, environmental contamination, patient length of mechanical ventilated days, length of stay, or mortality. Current evidence is limited by heterogeneity of study design and volume of studies; making it difficult to advocate for one system over the other. More research is required to inform and support clinical practice.