Open Suction Research Articles

INVESTIGATION OF AERODYNAMIC PERFORMANCE OF A NACA 0021 AIRFOIL MODIFIED WITH CAVITY

In this paper, an experimental investigation was conducted to investigate the effect of cavity on the NACA 0021 airfoil at low Reynolds number. The force measurement and smoke-wire flow visualization experiments were conducted in a low-speed open suction wind tunnel with a test section of 57cm×57cm×100 cm at a Reynolds number of 5.0×104 and 1.0×105. Two different airfoil models produced for the experiments such as base and cavity models. The diameter and location of the cavity was chosen as 0.08C and 80% x/C, respectively. The maximum lift coefficient of the cavity modified airfoil was increased about 6% for both positive and negative angles of attack compared to base airfoil at Reynolds number of 1.0×105. The cavity modified airfoil showed higher lift coefficient values at negative attack angles when compared to base airfoil at Reynolds number of 5.0×104.

Complete Closed-Loop Ventilatory Circuit Delays the Onset of Ventilator-Associated Pneumonia in Mechanically Ventilated Neurological Patients in the ICU: A Single-Center Prospective Preliminary Study

Abstract Background Ventilator-associated pneumonia (VAP) is preventable yet its incidence remains high. We compared conventional ventilator circuit with open suction and dual heated wire circuit (DHWC) with closed suction on the incidence of VAP. Methods This is a single-center, prospective cohort study conducted at a tertiary care hospital in neurological patients admitted to the neuro-intensive care unit (neuro-ICU) and requiring mechanical ventilation (MV) for more than 48 hours. Patients were ventilated using either conventional ventilator circuit with open suction (open group) or DHWC with closed suction (closed group) and were observed for VAP during the first 14 days of MV. The incidence and day of onset of VAP, duration of MV, duration of neuro-ICU and hospital stay, and mortality was noted in each group. Results A total of 63 patients were included (32 in open and 31 in closed group). The incidence of VAP was 9.3% in the open group and 12.9% in the closed group (p = 0.8). All the patients developed late VAP, that is, > 96 hours after intubation. However, as compared to the open group, VAP was observed much later in the closed group (day 7 vs. day 11). Duration of MV, neuro-ICU stay, hospital stay, and mortality did not differ significantly. Conclusion In this study, VAP incidences are similar in both the groups. However, neurological patients requiring MV for a short period might benefit from the usage of DHWC with closed suction system as VAP was seen to occur later in this group. Further, a randomized controlled trial with larger sample size is desired to confirm our findings.

Design and application of a new type of switchable semi-closed sputum suction device for transfer

Sputum suction is a necessary measure to remove respiratory secretions and collect sputum specimens, and the traditional sputum suction device includes open and closed methods. However, the open sputum suction device can easily cause sputum splashing during operation, polluting the operator and the surrounding environment. The closed sputum suction device is more expensive than the open sputum suction device. Although it can be used repeatedly, the friction between the protective sleeve and the wall of the suction tube increases after repeated uses, which in turn affects the operation. In addition, the two sputum suction methods need to be connected to a sputum collector when the sputum specimen is collected. This process can easily lead to leakage and contamination of specimens, and at the same time increase the infection risk for patients. In order to overcome the above problems, the medical staff from the department of critical care medicine of the First Affiliated Hospital of Dalian Medical University invented a new type of switchable semi-closed sputum suction device, and obtained the National Utility Model Patent of China (ZL 2020 2 1564712.3). The device is composed of a suction device connection port, a sliding negative pressure switch, an adapter interface, a pipe body, a transparent film protective sleeve, a clip-on connection joint, and a sputum collector. The sliding negative pressure switch at the connection port of the suction device can realize one-person one-handed operation. The sputum collector is connected with the sputum suction device to ensure that the specimen is not exposed. The transparent film protective sleeve covers the sputum suction tube body to ensure that the whole process of sputum suction operation is pollution-free. The clip-on connection joint is connected with the artificial airway interface to avoid sputum splashing during sputum suction, and it is clamped immediately after operation to reduce environmental pollution. Compared with the existing sputum suction device, the new switchable semi-closed sputum suction device has a more reasonable design and lower cost, which is worthy of clinical promotion.

Application of a New Type of Protective Sputum Suction Device in Clinic against Cross-Infection between Medical Staff and Patients.

To explore the clinical application of a new type of protective sputum suction device (PSSD) in patients with tracheotomy or tracheal intubation and to evaluate the protective effect of PSSD against cross-infection between medical staffs and patients. A novel PSSD was designed which can assist closed sputum suction operation without disconnecting the ventilator. 32 patients with tracheotomy were included to study the protective effect and safety of this device. Patients' vital signs including heart rate, respiratory rate, mean arterial pressure, and blood oxygen saturation were recorded to compare the influence of open suction and closed suction (performed with this novel device). To verify the antisplash effect of this device on airway secretions, bacterial samples were collected from the hands of the suction operators and the environment near the endotracheal tube orifice before and after the two suction processes. In addition, the satisfaction of the two suction methods was compared through the questionnaire of suction staff. Finally, with the assistance of this device, an attempt was made to complete the bronchoscopy without weaning of ventilator. Compared with open sputum suction, closed sputum suction has a smaller decrease in patients' blood oxygen saturation (P < 0.05), and no significant differences in other vital signs. Compared with open sputum suction, bacteria from the hands of suction staffs and the surrounding environment of the endotracheal tube were barely detected in closed suction. A questionnaire survey of sputum suction nurses suggested that the satisfaction with use and protective effect of the closed suction were better than open suction. In addition, bronchoscopy can be successfully completed with the assistance of this device, which is not possible for other breathing tubes. This closed sputum suction device has little effect on the oxygen saturation of patients but has excellent protective effects for medical staff against cross-infection. It has a unique advantage that can assist in completing the fiberoptic bronchoscopy with continuous ventilator-assisted breathing.

Implementing paediatric appropriate use criteria for endotracheal suction to reduce complications in mechanically ventilated children with respiratory infections

BackgroundEndotracheal suction is used to maintain endotracheal tube patency. There is limited guidance to inform clinical practice for children with respiratory infections. ObjectiveThe objective of this study was to determine whether implementation of a paediatric endotracheal suction appropriate use guideline Paediatric AirWay Suction (PAWS) is associated with an increased use of appropriate and decreased use of inappropriate suction interventions. MethodsA mixed-method, pre-implementation–post-implementation study was conducted between September 2021 and April 2022. Suction episodes in mechanically ventilated children with a respiratory infection were eligible. Using a structured approach, we implemented the PAWS guideline in a single paediatric intensive care unit. Evaluation included clinical (e.g., suction intervention appropriateness), implementation (e.g., acceptability), and cost outcomes (implementation costs). Associations between implementation of the PAWS guideline and appropriateness of endotracheal suction intervention use were investigated using generalised linear models. ResultsData from 439 eligible suctions were included in the analysis. Following PAWS implementation, inappropriate endotracheal tube intervention use reduced from 99% to 58%, an absolute reduction (AR) of 41% (95% confidence interval [CI]: 25%, 56%). Reductions were most notable for open suction systems (AR: 48%; 95% CI: 30%, 65%), 0.9% sodium chloride use (AR: 23%; 95% CI: 8%, 38%) and presuction and postsuction manual bagging (38%; 95% CI: 16%, 60%, and 86%; 95% CI: 73%, 99%), respectively. Clinicians perceived PAWS as acceptable and suitable for use. ConclusionsImplementation of endotracheal tube suction appropriate use guidelines in a mixed paediatric intensive care unit was associated with a large reduction in inappropriate suction intervention use in paediatric patients with respiratory infections.

Suction circuit flushing with chlorhexidine decreases ventilator-associated pneumonia: a quasi-experimental study.

Endotracheal suctioning of mechanically ventilated patients differs across the world. In many low and middle-income countries, endotracheal suctioning is often performed with a sterile suctioning catheter that is used for 12 h or during the length of one nursing shift. The effect of flushing multiple used endotracheal suction system with chlorhexidine after suctioning to reduce ventilator associated pneumonia (VAP) remains unclear. The aim of the study is to assess the effectiveness of flushing multiple-used open endotracheal suction catheters and suctioning system with chlorhexidine gluconate 0.2% to reduce VAP in mechanically ventilated patients in a resource-limited Intensive Care Unit (ICU). Due to the difficulty of blinding the intervention for nurses who perform endo-tracheal suction procedures, we adopted a quasi-experimental method with a randomized controlled trial design. A sample of 136 ICU patients were allocated to the intervention (n = 68) or control group (n = 68) between May and November 2020. The intervention was flushing the multiple-used suction catheter and suction system with 40ml chlorhexidine gluconate 0.2% and in the control group we used normal saline to flush the catheter and suction system. The primary outcome was incidence of VAP and the cost of the flushing solutions was the secondary outcome measure. Patients in the intervention group had a lower incidence of VAP compared to patients in the control group; 15 (22.1%) vs 29 (42.6%), p = 0.01. The incidence of late-onset VAP was 26.2% in the intervention group and 49% in the control group (p = 0.026) and the early-onset VAP was 13.2% in the intervention group and 25% in the control group (p = 0.081). Chlorhexidine gluconate 0.2% reduced the cost of suction system flushing (median: 78.4 vs 300 EGP, p < 0.001). Using chlorhexidine gluconate 0.2% to flush multiple-used suctioning catheters after every endo-tracheal suction procedure might reduce the incidence of VAP in mechanically ventilated patients. Chlorhexidine gluconate 0.2% can be a cost-effective solution for flushing the suction circuit. Nurses working in resource-limited ICUs and using suctioning catheters multiple times might consider using chlorhexidine gluconate 0.2% instead of normal saline or distilled water when flushing the suction system. ClinicalTrials.gov, identifier NCT05206721.

Comparison of the Effects of Open and Closed Endotracheal Suction Systems on Ventilator-Associated Pneumonia and Mortality

Aims: Nosocomial pneumonia is a prevalent complication in patients admitted to intensive care units. Endotracheal suction (ES) is used to clean the airways of secretions in patients under mechanical ventilation (MV). The objective of this study was to compare the effects of an open endotracheal suction system (OESS) versus a closed endotracheal suction system (CESS) on the incidence of ventilator-associated pneumonia (VAP).&#x0D; Study Design: Retrospective examination of hospital records.&#x0D; Place and Duration of Study: Reanimation Intensive Care Unit, Van Training and Research Hospital, Van, Turkey, between January 2018 and December 2019.&#x0D; Methodology: Age, gender, and length of stay in the intensive care unit and under mechanical ventilation (MV), mortality and isolated microorganism status of 73 (35.6%) patients with VAP were analyzed retrospectively. These features were compared according to the ES type applied. Sample: The study was conducted among 205 patients who were connected to a mechanical ventilator for more than 48 h in the reanimation intensive care unit (RICU) of a tertiary care hospital.&#x0D; Results: There was no difference between OESS and CESS groups in terms of mortality rates, length of stay in the RICU, and duration of MV. There was a significant difference in terms of incidence of VAP between the OESS group and the CESS group (41.8% and 29%, respectively; P = .045) Acinetobacter baumanii was the most frequently isolated microorganism in both groups.&#x0D; Conclusion: CESS treatment was associated with a lower incidence of VAP in patients of the RICU.

The Relation between Age and CadioRespiratory Parameter in Open and Closed Suction System for Mechanically Ventilated Patients

The Relation between Age and CadioRespiratory Parameter in Open and Closed Suction System for Mechanically Ventilated Patients

Comparison of the effects of open and closed aspiration on end-expiratory lung volume in acute respiratory distress syndrome.

Alveoli tend to collapse in patients with acute respiratory distress syndrome (ARDS). Endotracheal aspiration may increase alveolar collapse due to the loss of end-expiratory lung volume (EELV). We aimed to compare the loss of EELV after open and closed suction in patients with ARDS. This randomized crossover study included 20 patients receiving invasive mechanical ventilation for ARDS. Open and closed suction were applied in a random order. Lung impedance was measured using electric impedance tomography. The change in end-expiratory lung impedance end of suction and at 1, 10, 20, and 30 min after suction, was used to represent the change in EELV. Arterial blood gas analyses and ventilatory parameters such as the plateau pressure (Pplat), driving pressure (Pdrive), and compliance of the respiratory system (CRS) were also recorded. Less volume loss was noted after closed suction than after open suction (mean ΔEELI: -2661 ± 1937 vs. -4415 ± 2363; mean difference: -1753; 95% CI [-2662, -844]; P = 0.001). EELI returned to baseline 10 min after closed suction but did not return to baseline even 30 min after open suction. After closed suction, the Pplat and Pdrive decreased while the CRS increased. Conversely, the Pplat and Pdrive increased while the CRS decreased after open suction. Endotracheal aspiration may result in alveolar collapse due to loss of EELV. Given that closed suction is associated with less volume loss at end-expiration without worsening ventilatory parameters, it should be chosen over open suction in patients with ARDS.

Efficacy of Closed and Open Endotracheal Suction on Prevention of Ventilator-Associated Pneumonia on Patients Admitted to Critical Care Unit at Tertiary Care Hospital

Background: Endotracheal suctioning is a method commonly used to clean airway secretions in patients under mechanical ventilation. This study aimed to compare the effects of open and closed suction methods on the occurrence of ventilator-associated pneumonia (VAP). In the open endotracheal suction, the approach necessitates the participation of two nurses and may result in a momentary interruption of ventilation and oxygen supply due to the patient’s disconnection from the ventilation device during suctioning. In the closed endotracheal suction, the approach can be performed through connections in a closed suction set while the patient is ventilated without separating the patient from the ventilator. Objective: (1). To compare the close endotracheal suction with open endotracheal suction for the prevention of VAP. (2) To assess the incidence of VAP among intubated patients. Materials and Methods: The study was conducted among 60 patients who are on mechanical ventilator in the critical care unit in tertiary care hospital. For the study, simple random sampling technique is used for the selection of sample. Using a lottery method of sampling, one in the experimental group and one in the control group on the basis of inclusion criteria. Results: The study was done on patients who are on mechanical ventilators in the critical care unit in tertiary care hospitals. The data analysis was done using descriptive and inferential statistics. The study finding revealed that in VAP scoring of the patient’s 1st and 2nd day in open endotracheal suction, there are no significant changes in open endotracheal suction then null hypothesis was accepted (t = 0.9, P = 0.37). VAP scoring of the patient’s 2nd and 3rd day and 3rd and 1st day in open endotracheal suction, there are significant changes in open endotracheal suction method in null hypothesis was rejected (P &lt; 0.05). VAP scoring of the patient’s 1st and 2nd day and 2nd and 3rd day and 3rd and 1st day in closed endotracheal suction, there are significant changes in closed endotracheal suction then null hypothesis was rejected (P &lt; 0.05). Conclusion: The study assessed the efficacy of open endotracheal suction versus closed endotracheal suction on age, sex, duration of hospital stays, return of mechanical ventilation, and mode of ventilation are not significant but the duration of mechanical ventilation is significant. The nurses play a vital role in assessing the cardiac monitor while doing suctioning to prevent cardiorespiratory complications.

Closed Endotracheal Suction Systems for COVID-19: Rapid Review.

The increase in admissions to intensive care units (ICUs) in 2020 and the morbidity and mortality associated with SARS-CoV-2 infection pose a challenge to the analysis of evidence of health interventions carried out in ICUs. One of the most common interventions in patients infected with the virus and admitted to ICUs is endotracheal aspiration. Endotracheal suctioning has also been considered one of the most contaminating interventions. This review aims to analyze the benefits and risks of endotracheal suctioning using closed suction systems (CSS) in COVID-19 patients. A rapid review was carried out using the following databases: PubMed, MEDLINE, CINAHL, LILACS, the Cochrane Library, and IBECS. The data search included articles in English and Spanish, published between 2010 and 2020, concerning adult patients, and using the key words "endotracheal," "suction," and "closed system." A total of 15 articles were included. The benefits and risks were divided into 3 categories: patient, care, and organization. Relating to the patient, we found differences in cardiorespiratory variables and changes in the ventilator, for example, improvement in patients with elevated positive and end-expiratory pressure due to maladaptation and alveolar collapse. Relating to care, we found a shorter suctioning time, by up to 1 minute. Relating to organization, we found fewer microorganisms on staff gloves. Other conflicting results between studies were related to ventilator-associated pneumonia, bacterial colonization, or mortality. Aside from the need for quality research comparing open suction systems and CSS as used to treat COVID-19 patients, closed endotracheal suctioning has benefits in terms of shorter stay in the ICU and reduced environmental contamination, preventing ventilator disconnection from the patient, reducing the suctioning time-though it does produce the greatest number of mucosal occlusions-and preventing interpatient and patient-staff environmental contamination. New evidence in the context of the SARS-CoV-2 virus is required in order to compare results and establish new guidelines.

Comparison Between the Effect of Open and Closed Tracheal Suction Systems on Physiological Parameters of Critically Ill Patients

Comparison Between the Effect of Open and Closed Tracheal Suction Systems on Physiological Parameters of Critically Ill Patients

Closed versus open endotracheal tube suction in mechanically ventilated neonates: a randomized controlled trial

In a unit with a low incidence of VAP, the effect of the endotracheal suction method alone did not impact the occurrence of VAP in the study population. CTRI/2020/03/023679; Date: 17.02.2020. • Better physiological stability of the closed-suctioning method on short-term measures including noticeably fewer episodes of hypoxia, a smaller drop in TcPO2 levels, and less variability in heart rate and bradycardia episodes. • In a unit with a low incidence of VAP in the neonates, randomized control trial studying the effect of the endotracheal suction method alone did not impact the occurrence of VAP amongst the study population.

The Effect of Closed Versus Open Suction on Cardiorespiratory Parameters in Mechanically Ventilated Children

The Effect of Closed Versus Open Suction on Cardiorespiratory Parameters in Mechanically Ventilated Children

Design and application of an extension tube for ventilator pipeline

At present, the extension tube of the ventilator, a long corrugated tube used in clinical practice, needs to be disconnected from the endotracheal tube when performing open sputum suction. Under positive pressure, the condensed water containing pathogenic microorganisms in the ventilator will be splashed. Some will form aerosol suspended in the air, pollute the air, increase the risk of cross-infection and operator pollution, while the ventilator will emit a corresponding alarm sound, resulting in noise pollution. Based on the above factors, a ventilator pipeline extension tube was designed by the medical staff of department of critical care medicine of the Eighth Medical Center of People's Liberation Army General Hospital and department of critical care medicine of Beijing Friendship Hospital of Capital Medical University, and was obtained the National Utility Model Patent of China (ZL 2020 2 1476518.X). The device consists of the main pipe, first pipe sleeve, second pipe sleeve, valve body, joystick, axial sleeve, etc., which can not only effectively avoid air pollution and reduce the risk of cross-infection, but also reduce noise pollution and the negative impact of loud noise on patients and medical staff.

Comparison of Closed vs Open Suction in Prevention of Ventilator-associated Pneumonia: A Systematic Review and Meta-analysis.

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 (MV). 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) vs 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. 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). Our results showed that using CTSS can significantly decrease VAP development compared to OTSS. This conclusion does not yet mean the routine use of CTSS as a standard VAP prevention measure for all patients since individual patient's disease and cost are other factors that should be in mind when determining the choice of the suctioning system. High-quality trials with a larger sample size are highly recommended. Sanaie S, Rahnemayan S, Javan S, Shadvar K, Saghaleini SH, Mahmoodpoor A. Comparison of Closed vs Open Suction in Prevention of Ventilator-associated Pneumonia: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2022;26(7):839-845.

Application of Transurethral Prostate Resection Instrumentation for Treating Low Rectal Anastomotic Leakage: A Pilot Study.

PurposeTo determine an accurate method of inspecting low anastomotic leakages and application of transurethral prostate resection instrumentation for treating low rectal anastomotic leakage.Patients and MethodsClinical data of eight patients treated for anastomotic leakage after rectal cancer surgery at Zhangye People’s Hospital (affiliated to Hexi University), from August 2019 to November 2021, were retrospectively analyzed. Transanal prostate resection instrumentation was used to assess the leakage and surrounding conditions. Using prostate resection instrumentation, the presacral and perirectal residual cavities were washed and removed, and indwelling suprapubic presacral, transanal presacral, and rectal drainage tubes were placed. Continuous presacral saline irrigation and drainage and open negative-pressure suction in the rectal cavity were performed until the patients’ fistula healed.ResultsOf the eight patients with anastomotic leakages, one had grade B and seven had grade C International Study Group of Rectal Cancer anastomotic leakage classifications following Dixon operation. Transanal prostate resection instrumentation showed that the leakage of the one patient with grade B was less than a third of the circumference of the anastomosis. Among the seven patients with grade C, one leakage was less than a third of the anastomotic circumference. One patient had complete separation of the anastomosis and one distal colon necrosis, which necessitated immediate descending colostomy. Conservative treatment was successful in six patients; the conservative overall cure rate was 75%, and the median healing time was 43 (21–68) days.ConclusionTransanal examination of rectal anastomotic leakage using prostate resection instrumentation is comprehensive, easy to perform, provides clear visualization, accurately guides catheter placement, and can be combined with continuous open negative-pressure drainage, which is a safe, convenient, and effective method for treating low rectal leakage.

A NOVEL ALTERNATIVE FOR DETECTING ENDOTRACHEAL TUBE BLOCK IN A RESOURCE-LIMITED SETTING DURING COVID-19 PANDEMIC

TYPE: Case Report TOPIC: Respiratory Care PURPOSE: A large number of critically ill Covid-19 patients requiring mechanical ventilation globally. Endotracheal tube block is a common complication of mechanically ventilated patients. Detecting an endotracheal tube block is a challenge in a resource-limited setting. Intubation poses a high risk of increases aerosol exposure to health care workers. METHODS: 25 mechanically ventilated patients with suspected ET tube block were considered after prior written consent. Teslong 3.9 mm Borescope(Cost- 200 USD) was used in the study. A borescope is an optical device used for inspection of difficult access places it consists of a camera at one end of a semi-rigid tube and a 4.5 inch HD display at the other end. The adaptor for the open suction system was used to pass the borescope into the endotracheal tube since its easy availability in resource-constrained settings. The borescope was passed through the endotracheal tube and inspection of the endotracheal tube was done. RESULTS: 18 patients had endotracheal tube block due to airway secretion and mucous plugging, 2 patients had endotracheal tube bites and 5 patients endotracheal tube was normal. The average time for visual inspection was 80 seconds in the 25 patients and no complication was observed during or post-procedure. CONCLUSIONS: This novel borescope inspection is an excellent and rapid tool for visual inspection for detection of endotracheal tube block in critically ill patients during the covid 19 pandemic. This affordable and novel approach makes it ideal for usage in a resource-limited setting. CLINICAL IMPLICATIONS: The technique is ideal for detecting ET block in a resource-limited setting DISCLOSURE: Nothing to declare. KEYWORD: ET block, Covid 19, recourse limited setting, critical care, respiratory care, training

Вентиляционные течения в турбулизированной среде производственных помещений

The turbulent air environment in industrial premises intensively affects the characteristics of air and heat and gas jets and thereby the effectiveness of various industrial ventilation devices. This effect manifests itself in the accelerated expansion of the main sections of the jets and in the reduction of their range of action. Until recently, the influence of the intensity of air turbulence was not taken into account in the corresponding calculation and design methods. The article proposes methods for calculating air jets and the efficiency of open local suction, taking into account the influence of a turbulized air environment.

Investigation of the airway management practice of emergency department ward nurses: a nationwide survey in China

ObjectivesTo investigate the airway management equipment and clinical practice in emergency department wards in China, and to explore the factors that influenced the nurses’ airway management practice.DesignCross-sectional study.SettingA nationwide survey...