Closed Suction Catheter Research Articles

Suctioning in intubated and tracheotomized patients : Anarrative review

Endotracheal suctioning in intubated or tracheotomized critically ill patients is adaily task of various professional groups in intensive and emergency medicine; however, aGerman language summary of current evidence is lacking. The aim is to develop anarrative overview of current evidence on endotracheal suctioning of intubated or tracheotomized patients in the clinical setting. Aliterature search was conducted in the databases Cinahl, Cochrane Library, Livivo, and Medline via PubMed by nurses with an academic degree. In addition, ahand search and applying the snowball principle were performed. Following asuccessful critical appraisal, all English and German language publications addressing endotracheal suctioning in the context of hospital care were included. Atotal of 23 full texts were included. After developing 6 main topics on endotracheal suction 19articles were considered in the reporting. The results showed, among others, that routine deep suctioning once per shift is contraindicated and that the catheter should be advanced no more than 0.5-1 cm beyond the distal end of the tube or tracheal cannula. Closed suction catheters offer advantages, especially for staff protection, although studies are heterogeneous. Further training of staff is obligatory. Few conclusive studies on endotracheal suction could be found; however, with the available evidence initial conclusions can be drawn which should be considered in, for example, internal standard operating procedures. Further research is needed.

An in vitro study of the effects of respiratory circuit setup and parameters on aerosol delivery during mechanical ventilation.

Aerosol therapy is often prescribed concurrently during invasive mechanical ventilation (IMV). This study determines the effects of nebuliser position, circuit humidification source, and most importantly, lung health on the delivery of aerosol in simulated adult and paediatric IMV patients. Furthermore, the influence of closed suction catheters on aerosol delivery is also addressed. A vibrating mesh nebuliser was used to deliver Albuterol to simulated adult and paediatric IMV patients with differing states of lung health. Four different nebuliser positions and two types of humidification were analysed. Closed suction catheter mounts, a mainstay in IMV therapy, were incorporated into the circuits. The mean ± SD dose of aerosol (%) was assayed from a filter at the distal end of the endotracheal tube. Nebuliser placement and circuit humidification source had no effect on the delivered dose (%) in adults, yet both significantly did in the simulated paediatric patients. The use of closed suction catheter mounts significantly reduced the delivered dose (%) in adults but not in paediatric patients. A simulated healthy lung state generated the largest delivered dose (%), irrespective of nebuliser position in the adult. However, different lung health and nebuliser positions yielded higher delivered doses (%) in paediatrics. Lung health and respiratory circuit composition significantly affect aerosol delivery in both adult and paediatric IMV patients. Nebuliser placement and respiratory circuit humidification source do not affect the delivered dose in adult but do in paediatric IMV patients.

Evaluation of a novel endotracheal tube suctioning system incorporating an inflatable sweeper.

IntroductionAccumulation of secretions in an endotracheal tube can increase the resistance to flow resulting in an increased patient work of breathing when the patient is interacting with the ventilator. Retained secretions can also serve as an infection risk. Standard suction catheters are limited in their ability to keep the lumen of the endotracheal tube clear. A novel closed-suction catheter has been introduced that incorporates a balloon at its distal end that, when inflated, physically scrapes secretions out of the endotracheal tube (CleanSweep catheter (CSC), Teleflex, Morrisville NC). We hypothesized that the CSC would be more efficient at removing secretions from inside the endotracheal tube than a standard suction catheter (SSC).MethodsWe performed a bench study examining resistive pressures across different sizes of endotracheal tubes when cleaned by the CSC as compared with an SSC. This study was followed by a prospective crossover study again comparing the CSC with an SSC in intubated intensive care unit patients receiving mechanical ventilation and requiring frequent suctioning.ResultsFor the bench study the CSC was significantly better in reducing airway resistive pressures (P < 0.001). In the prospective crossover study the CSC over 2 h also removed significantly more secretions than the SSC (P < 0.05).ConclusionBoth our bench and crossover clinical study demonstrated improved clearance of secretions with the CSC vs an SSC. Further research is needed to ascertain the clinical outcome benefits of enhanced secretion removal.

Closed endotracheal suction catheter system related complications in mechanically ventilated COVID-19 patients.

Sir, In the current coronavirus disease 2019 (COVID-19) pandemic, about 15% of patients may develop severe disease and 5% critical disease requiring admission to an intensive care unit (ICU) and mechanical ventilation.[1] In mechanically ventilated patients, closed endotracheal suctioning system is used to prevent disconnection of circuit and consequent de-recruitment of alveoli and to prevent aerosolisation of droplets and potential contamination of surroundings.[23] However, in times of sudden surge in cases, trained ICU staff may not be always available. Moreover, efficiency is reduced after wearing personal protective equipment (PPE) and visibility may turn poor due to fogging of goggles. Therefore, inadvertent human errors may occur. We report two such cases involving the use of in-line closed suction catheter system (DAR™ closed suction system, Covidien Ireland Limited). In the first case, we noticed that the closed suction catheter was not completely withdrawn outside after suctioning was complete and the rotatory access knob was closed. Presence of part of the suction catheter inside the endotracheal tube led to increase in the peak airway pressures and frequent ventilator alarms that was initially interpreted as bronchospasm [Figure 1a]. However, a very close inspection revealed the actual problem. In another case, although the suction catheter was completely withdrawn, the rotating access knob was not closed, which led to significant leak in the circuit and activation of ventilator alarms [Figure 1b]. Inflated plastic sheath covering of the closed suction system revealed this problem. These kinds of problem may lead to unnecessary troubleshooting warranting treatment/interventions (like treating with bronchodilators in case of misdiagnosed bronchospasm or inflating the pilot balloon further in case of leak), which may even harm the patient (like barotrauma or alveolar de-recruitment). Fortunately, in both our cases, the actual problems were identified and no adverse events were seen. Problems like blocked tip of closed suction catheter leading to inadequate suctioning[4] and migration of piece of closed suction catheter leading to bronchial obstruction have been already reported.[5]Figure 1: (a) Closed suction catheter (black arrow) partially kept inside endotracheal tube and difficult to detect due to transparent colour of distal part of the catheter; (b) rotating access knob was not closed causing leak and overinflated plastic sheathing (white arrow)While the nursing staff were aware of the standard operating procedures for the closed suction system in ICU, impaired visibility due to fogging of goggles was the reason reported behind such inadvertent mistakes in both the cases. The fogging issue has been addressed by regular use of antifogging markers.[6] However, we would like to suggest two design modifications of the closed suction system. First, the colour of the in-line catheter may be made more conspicuous throughout the length of the catheter. The suction catheter of DAR™ closed suction system (Covidien Ireland Limited) is blue in the advancing end while being transparent towards the tail end [Figure 1b] and may evade detection if left inside the ventilator circuit with suboptimal visibility while working with PPEs. Second, an in-line self-sealing valve/diaphragm may be placed at the rotatory access knob to eliminate the risk of circuit leak in case the rotating access knob is inadvertently left open. To conclude, impaired visibility due to fogging of goggles may lead to inadvertent errors while operating equipment like closed suction catheter system in COVID-19 ICUs. Heightened vigilance and appropriate troubleshooting interventions might avoid and resolve such unintentional mistakes. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Detection and quantification of exhaled volatile organic compounds in mechanically ventilated patients - comparison of two sampling methods.

Exhaled breath analysis is a promising new diagnostic tool, but currently no standardised method for sampling is available in mechanically ventilated patients. We compared two breath sampling methods, first using an artificial ventilator circuit, then in "real life" in mechanically ventilated patients on the intensive care unit. In the laboratory circuit, a 24-component synthetic-breath volatile organic compound (VOC) mixture was injected into the system as air was sampled: (A) through a port on the exhalation limb of the circuit and (B) through a closed endo-bronchial suction catheter. Sorbent tubes were used to collect samples for analysis by thermal desorption-gas chromatography-mass spectrometry. Realistic mechanical ventilation rates and breath pressure-volume loops were established and method detection limits (MDLs) were calculated for all VOCs. Higher yields of VOCs were retrieved using the closed suction catheter; however, for several VOCs MDLs were compromised due to the background signal associated with plastic and rubber components in the catheters. Different brands of suction catheter were compared. Exhaled VOC data from 40 patient samples collected at two sites were then used to calculate the proportion of data analysed above the MDL. The relative performance of the two methods differed depending on the VOC under study and both methods showed sensitivity towards different exhaled VOCs. Furthermore, method performance differed depending on recruitment site, as the centres were equipped with different brands of respiratory equipment, an important consideration for the design of multicentre studies investigating exhaled VOCs in mechanically ventilated patients.

ClearPro Closed Suction Catheter

Biomedical Safety & Standards: December 15, 2020 - Volume 50 - Issue 22 - p 172 doi: 10.1097/01.BMSAS.0000724984.69624.3b

ClearPro Closed Suction Catheters

Biomedical Safety & Standards: October 15, 2020 - Volume 50 - Issue 18 - p 140 doi: 10.1097/01.BMSAS.0000718156.00988.ca

A novel way of removing an endotracheal suction catheter foreign body in a preterm neonate: A case report and review of literature

Airway obstruction by foreign bodies (FBs) in preterm neonates is a rare occurrence. Most of these FBs are iatrogenic and related to medical devices used in the neonate. We describe a case of an endotracheal FB resulting from the cut end of an in-line closed suction catheter. The FB caused collapse/consolidation of different lung lobes with changes in its position. It was missed for a long period of about 3 weeks and was removed by applying direct suction through an endotracheal tube. Different innovative devices have been used to retrieve endotracheal FBs in small preterm neonates; however, this method is not reported in literature to our knowledge.

Medline Closed Suction Catheters

Biomedical Safety & Standards 48(2):p 13, February 01, 2018. | DOI: 10.1097/01.BMSAS.0000530104.90094.92

Angle Effect to Dropping of Dew in Closed Suction Catheters

Intratracheal aspiration in a patient on ventilation is generally performed using a catheter. Of late, closed suction systems have been used more frequently than open systems. To remove tracheal secretions through the intratracheal tube, catheter suction is used, and the suction catheter may be of the closed- or open-type. The catheters are cleaned by flushing with sterile 0.9% saline, resulting in dropping of dew. This phenomenon is caused by some factors: influence of flow, clogging of the suction tube, problem of manipulation of flushing and angle between the intubation tube and the connection port. But this dropping has not yet been investigated. In this study, we focused at this angle and we used the test lung which is simulated machine on behalf of patient. We consider two situations adult and child, also two types of catheters Eco-Cath and Ty-care. In child case we consider elbow-type suction catheters and Y-connector type. The angle was set at 0°, 20°, 40°, 60°, and 90°, and we observed the difference between Eco-Cath and Ty-care. In adults difference is significant (p 0.001), In 90° between Tracheal intubation and Tracheotomy (p ≈ 0.26). In child difference is significant (p 0.001), In 90° between Tracheal intubation and Tracheotomy (p ≈ 0.15). In child case we observed dependency of angle on various conditions too. The relation of the angle and dew was clarified.

Application of closed suction catheter to the mechanical ventilation of critically ill newborn pneumonitis

Objective To investigate the application effect of closed suction catheter to the mechanical ventilation of newborn pneumonitis. Methods A total of 35 severe pneumonia children were received in our NICU with tracheal intubation to conduct mechanical ventilation. Closed suction catheter was used to suck phlegm and compare the physiological sign changes before and after sucking phlegm. Results SPO and heart rate had no significant change before and after using closed suction catheter to suck phlegm. Conclusion Closed suction catheter can effectively clear the secretions of air passage in this group, and the influence is small on the physiological signs of children, which can reduce consumable items, cost, save time, reduce the workload of nurse. Key words: Closed endotracheal suction; Neonatal severe pneumonia; Mechanical ventilation

A Closed-Suction Catheter with a Pressure Valve Can Reduce Tracheal Mucosal Injury in Intubated Patients

Background: Endotracheal suctioning is associated with complications that include bleeding, infection, hypoxemia, cardiovascular instability, and tracheal mucosal injury. Recently, a closed-suction catheter with a pressure valve (Acetrachcare, AceMedical Co., Republic of Korea) was developed. We hypothesized that this new catheter might reduce tracheal mucosal injury compared to a conventional closed-suction catheter (Trachcare, Kimberly-balla RD, USA). Methods: This prospective, randomized study enrolled medical and surgical patients who required mechanical ventilation for more than 48 hours. Patients were randomized into two groups: one group was suctioned with the conventional closed-suction catheter (CCC) and the other group was suctioned with the closed-suction catheter with pressure valve (CCPV). Bronchoscopy was performed 48 hours later, and the severity of tracheal mucosal injury was graded on a 5-point scale, as follows: 0 = normal; 1 = erythema or edema; 2 = erosion; 3 = hemorrhage; and 4 = ulceration or necrosis. Results: A total of 76 patients (37 with CCPV and 39 with CCC) were included. There were no significant differences between the groups regarding demographic characteristics, changes in hemodynamic parameters during suction, incidence of pneumonia, length of intensive care unit (ICU) stay, or ICU mortality. On bronchoscopic evaluation, the use of the CCPV led to a significant decrease in tracheal mucosal injury (median tracheal mucosal injury grade 1 [IQR 0-1] vs. 2 [IQR 1-3], p = 0.001). Conclusions: We conclude that the novel closed-suction catheter with pressure valve may reduce tracheal mucosal injury compared to conventional catheters.

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Introduction: Endotracheal suctioning is associated with complications including bleeding, infection, hypoxemia, cardiovascular instability, and tracheal mucosal injury. A closed-suction catheter has some advantages, which include minimizing risk of hypoxemia and prevention of infected secretions during suctions. Recently, a closed-suction catheter with pressure valve (Acetrachcare, AceMedical Co., South Korea) was developed. We hypothesized that this new catheter might reduce tracheal mucosal injury compared with conventional closed-suction catheter (Trachcare, Kimberly-balla RD, USA). Methods: The prospective, randomized study included medical and surgical patients requiring mechanical ventilation for more than 48 hours. Patients were randomized into two groups; one group was suctioned with the conventional closed-suction catheter (CCC) and the other group with the closed-suction catheter with pressure valve (CCPV). In CCC group, the wall suction vacuum pressure was kept around 100 mmHg. In CCPV group, the level of pressure used to perform endotracheal suction was adjusted by intensivist according to sputum amount (small, moderate or large). Bronchoscopy was performed 48 hours later, and the severity of tracheal mucosal injury was graded from 0 to 4, as follows: 0 = normal; 1 = erythema or edema; 2 = erosion; 3 = hemorrhage; 4 = ulceration or necrosis. Results: A total of 63 patients (31 with CCPV and 32 with CCC) were included. There were no significant differences between groups about age, sex, diagnosis groups, sputum appearance, mortality, and Acute Physiology and Chronic Health Evaluation II score. No significant difference was found in hypoxemia, hypercapnia, maximal heart rate, arrhythmia, mean arterial pressure and elevated airway pressure during suctioning. On bronchoscopic evaluation, the usage of CCPV led to a significantly reduce tracheal mucosal injury (median tracheal mucosal injury grade 0 [IQR 0–1] vs 2 [IQR 1–2], p<0.05). However, there were no differences in nurse satisfaction, total number of suction for 24 hours, microbial growth and the prevalence of ventilator-associated pneumonia. Conclusions: We conclude that the novel closed-suction catheter with pressure valve may reduce tracheal mucosal injury compared to conventional catheter.

Lung Volume Changes During Cleaning of Closed Endotracheal Suction Catheters: A Randomized Crossover Study Using Electrical Impedance Tomography

Airway suctioning in mechanically ventilated patients is required to maintain airway patency. Closed suction catheters (CSCs) minimize lung volume loss during suctioning but require cleaning post-suction. Despite their widespread use, there is no published evidence examining lung volumes during CSC cleaning. The study objectives were to quantify lung volume changes during CSC cleaning and to determine whether these changes were preventable using a CSC with a valve in situ between the airway and catheter cleaning chamber. This prospective randomized crossover study was conducted in a metropolitan tertiary ICU. Ten patients mechanically ventilated via volume-controlled synchronized intermittent mandatory ventilation (SIMV-VC) and requiring manual hyperinflation (MHI) were included in this study. CSC cleaning was performed using 2 different brands of CSC (one with a valve [Ballard Trach Care 72, Kimberly-Clark, Roswell, Georgia] and one without [Portex Steri-Cath DL, Smiths Medical, Dublin, Ohio]). The maneuvers were performed during both SIMV-VC and MHI. Lung volume change was measured via impedance change using electrical impedance tomography. A mixed model was used to compare the estimated means. During cleaning of the valveless CSC, significant decreases in lung impedance occurred during MHI (-2563 impedance units, 95% CI 2213-2913, P < .001), and significant increases in lung impedance occurred during SIMV (762 impedance units, 95% CI 452-1072, P < .001). In contrast, cleaning of the CSC with a valve in situ resulted in non-significant lung volume changes and maintenance of normal ventilation during MHI and SIMV-VC, respectively (188 impedance units, 95% CI -136 to 511, P = .22; and 22 impedance units, 95% CI -342 to 299, P = .89). When there is no valve between the airway and suction catheter, cleaning of the CSC results in significant derangements in lung volume. Therefore, the presence of such a valve should be considered essential in preserving lung volumes and uninterrupted ventilation in mechanically ventilated patients.

Fibrin sealant for the prevention of axillary seroma formation after axillary lymph node disection. A prospective randomized study.

Abstract Abstract #4139 Background&amp;#x2028; The most frequent postoperative complication after axillary limph node dissection is the axilary seroma (AS) formation. Currently accepted practice includes insertion of one or more drainage system for fluid evacuation. Several methods have been proposed to decrease AS formation, such as closed suction catheters, shoulder immobilisation, tetracycline sclerotherapy, talc podrage and closure of dead space; however no of them have reduced the incidence of AS. Seromas are associated with wound infection, wound dehiscence and skip flap necrosis, which prolong the recovery and can extend patient´s stay in Hospital.&amp;#x2028; The aim of this prospective randomized controlled trial was to evaluate the efficacy of fibrin sealant (FS) on the prevention of AS.&amp;#x2028; Material and Methods&amp;#x2028; Sixty-two patients undergoing axillary lymph node dissection were randomized to treatment with drainaje alone (arm A, n=49), drainage plus FS (arm B, n=12), or FS alone (arm C, n=53). Arm B was cancelled after primary results. Efficacy was evaluated in terms of lengh of hospital stay, volumen of fluid drainage and rate of wound related complications (seroma, hematoma, infection, dehiscence) in each arm.&amp;#x2028; Results&amp;#x2028; No significative differences are detected neither type of surgery, nor histlogycal characteristics.&amp;#x2028; &amp;#x2028; The mean result is a difference of almost minus 3 days in postoperative stay in the FS group.&amp;#x2028; &amp;#x2028; Conclusions&amp;#x2028; 1- Application of fibrin sealant reduces the amount of serosanguinous drainage and the length of postoperative stay in patients who have undergone axillary lymph node dissection.&amp;#x2028; 2- Fibrin sealant allows to avoid the insertion of an axillar drainage system&amp;#x2028; 3- It is very important the correct preparation and application of the fibrin sealant and it should be performed by a qualified surgeon.&amp;#x2028; 4- Future clinical trials toasses the role of fibrin sealant seroma are warranted. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4139.

Experimental Contamination of a Closed Endotracheal Suction System: 24 h vs 72 h

To ascertain the desirability of replacing closed suction systems after 72 h rather than after 24 h (manufacturer's recommendations) because it is possible that a reduction in the frequency of manipulations might reduce the risk of exogenous nosocomial pneumonia. We investigated the presence of time-dependent differences (after 24 h and 72 h) in pathogen survival/growth in artificially contaminated closed suction catheters (OptiFlo). The trial simulated bacterial contamination of the airways using a suspension of 2 x 10(3) CFU/ml of Staphylococcus aureus or Pseudomonas aeruginosa. Contamination was performed on a total of 80 catheters. Forty were contaminated a total of eight times every 45-60 min. Another 40 catheters underwent the same procedure 24 times over three consecutive days. Microbiological analysis of the catheters took place after 24 h and 72 h, respectively. The mean S. aureus load was 9.4 CFU/catheter after eight suction procedures and 6.2 CFU/catheter after 24 suction procedures (3 days). Mean growth of P. aeruginosa was 5.3 CFU/catheter, and 8.2 CFU/catheter after 3 days. There was no statistically significant difference between day 1 and 3 for S. aureus (p = 0.474), but there was for P. aeruginosa (p = 0.004). Our findings show that, from an experimental point of view, it remains controversial whether routine change of closed suction catheters can be extended from 24 h to 72 h. However, clinical evidence suggests that prolonged use of a closed suctioning system is safe.

Fractured closed suction catheter: an unusual cause of endobronchial obstruction in a ventilated patient

A 32-year-old HIV-positive man required ventilation for seizures secondary to viral encephalitis. He had a prolonged care unit stay and had percutaneous tracheostomy performed on day 14 of his admission. He subsequently developed persistent right basal infiltrates and atelectasis on chest radiographs that were slow to respond to antibiotic treatment. Fiberoptic bronchoscopy revealed the cause of his infiltrates to be a 14-cm tip section of closed suction catheter tubing that had presumably fractured during suctioning and became lodged in his trachea and right main bronchus. Foreign body aspiration should be considered in the differential diagnosis of persisting lung infiltrates or atelectasis in all patients. This case describes a rare cause of endobronchial obstruction in a ventilated patient. Medical staff requires education about the importance of ensuring that suction catheters and other airway adjuncts are intact following use to prevent possible airway foreign bodies.

The closed tracheal suction catheter: 24 hour or 48 hour change?

Closed suction catheters (CSC) for removal of bronchial secretions in intubated patients have been used in intensive care units (ICU) for many years. Manufacturers still recommend daily changes of the catheter in order to reduce the incidence of ventilator associated pneumonia (VAP). There is, however, a lack of clinical evidence to support this recommendation. The objective of this study was therefore to compare the incidence of VAP in patients who receive either 24 hourly or 48 hourly changes of the CSC. Eligible patients were randomised to one of the two groups to receive either a 24 hourly change (n=53) or a 48 hourly change (n=48) of the CSC. Sputum specimens were sent second daily for quantitative culture. Chest x-rays (CXR) and white blood cell counts were attended daily. A VAP was diagnosed according to previously established criteria. A second set of modified criteria were also used to conduct a further analysis of the results. Of the 158 patients randomised, 101 completed the study. These patients had a mean age of 65 years and a mean APACHE II score of 28.2 in the first 24 hours of the study. The average duration in the trial was 10 days. The two groups were comparable in terms of demographic features. There were no reported cases of VAP in either group using the criteria originally selected in the study design. Using a modified criteria to diagnose VAP there were 10 (19%) patients with VAP in the 24 hour group and 13 (27%) in the 48 hour group. The incidence of VAP between the two groups was not statistically different (p=0.35). To conclude, there was no difference in the incidence of VAP between the two groups studied. Based on previous studies conducted by Quirke 1 and Kollef 2 and the experience of our study we have changed our clinical practice to a 48 hour change of the CSC. We would, however, suggest further study or a meta-analysis of the available literature before a recommendation is made.

Prevention of ventilator-associated pneumonia: Current practice in Canadian intensive care units

Objective: To evaluate the current use of strategies to prevent ventilator-associated pneumonia (VAP) and to identify interventions to target for quality-improvement initiatives. Design: Cross-sectional national survey. Setting: Canadian intensive care units (ICUs) with at least 8 beds. Patients: Seven hundred and two patients in 66 ICUs in 10 provinces in Canada. Interventions: None. Measurements and Results: The Canadian Critical Care Trials Group recently developed VAP prevention guidelines. Before these guidelines were disseminated, we documented the extent to which these recommendations were followed in practice by using 3 methods: survey of ICU directors, prospective observation of patients on one day, and retrospective review of patient charts for a 12-day period. According to ICU directors, ventilator circuits were changed only for new patients or if the circuit was soiled in 7 of 66 ICUs (10%), heat and moisture exchangers were used routinely in 53 of 66 ICUs (80%), and closed-suction catheter systems were used in 58 of 66 ICUs (88%). Neither subglottic secretion drainage tubes nor prophylactic antibiotics for VAP were used at all. Of the entire cohort of 702 patients, the average degree of elevation of the head of the bed was 29.9° (range, 0°−90°) and 22 of 702 (3.1%) were observed to be on a kinetic bed. Of the 459 patients receiving any form of mechanical ventilation, 56 (12.2%) were receiving noninvasive or mask ventilation, 262 (57.1%) were orally intubated, 9 (1.9%) were nasally intubated, and 132 (28.8%) had received a tracheostomy. Of the 423 patients who received nutrition support, 373 (88.2%) received enteral nutrition. Small bowel feeding tubes were used during 16.4% of study days on enteral feeds and sucralfate was prescribed for 1.7% of study days. Conclusions: Significant opportunities exist to improve VAP prevention practices in Canada. These strategies include decreasing the frequency of ventilator circuit changes, and increasing the use of non-invasive ventilation, subglottic secretion drainage endotracheal tubes, kinetic bed therapy, small bowel feedings, and elevation of the head of the bed. Copyright 2002, Elsevier Science (USA). All rights reserved.

Hypoxaemia during tracheal suctioning; comparison of closed versus open techniques at varying PEEP

Suctioning of artificial airways is a necessary procedure but is not without risk. Hypoxaemia is a recognised complication. Several small studies have suggested that closed suction catheters offer benefits over open suction because disconnection from the ventilator circuit is not required [1], thereby maintaining ventilation, FIO2 and PEEP. Other studies have sought to prove the maintenance of lung volume and cardiovascular stability with closed suction [2]. There is little evidence that closed suction systems offer clinical advantage over open suction in terms of arterial oxygenation. No published study had compared changes in PaO2/FIO2 post suction. We performed a study in critically ill adults to identify any differences in PaO2/FIO2 between closed and open suction for a given PEEP.