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Liang Z, Liao Q, Xu J, Wang S, Liu Q, Liu Z, Wen D. Comparative analysis of open and closed tracheal suction systems on mechanical ventilation efficiency in adults: A systematic review and meta-analysis. Aust Crit Care 2024:S1036-7314(24)00243-1. [PMID: 39242302 DOI: 10.1016/j.aucc.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/19/2024] [Accepted: 08/08/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND There are two types of suction methods used clinically: closed tracheal suction system (CTSS) and open tracheal suction system (OTSS). However, the safety and efficacy of these two suction systems for patients remain to be analysed. OBJECTIVE The objective of this study was to assess the safety and efficacy of OTSSs and CTSSs in adult mechanical ventilation. METHODS Computer searches were conducted on PubMed, Web of science, MEDLINE, CINAHL, and Cochrane Library databases. The search spanned from the inception of each database to December 2023. Two researchers independently reviewed and extracted data from the literature. Quality assessment was performed using the Cochrane Manual of Systematic Reviews, and meta-analysis was conducted using RevMan 5.3 software. RESULTS A total of 13 articles, involving 2822 patients, were included in the analysis. The meta-analysis showed that the CTSS could reduce the incidence of ventilator-associated pneumonia (odds ratio [OR] = 0.77, 95% confidence interval [CI]: [0.61, 0.98], P = 0.03). However, no significant difference existed in the microbial colonisation rate in the respiratory tract (OR = 1.40, 95% CI: [0.91, 2.15], P = 0.13), mechanical ventilation time (mean difference = -0.33, 95% CI: [-1.43, 0.78], P = 0.56), length of intensive care unit stay (mean difference = 0.23, 95% CI: [-0.90, 1.35], P = 0.69), and mortality (OR = 1.01, 95% CI: [0.84, 1.22], P = 0.89). CONCLUSION In comparison to the OTSS, the CTSS proves effective in reducing the incidence of ventilator-associated pneumonia. However, additional high-quality evidence is needed to evaluate respiratory microbial colonisation rates, the duration of mechanical ventilation, length of intensive care unit stay, and mortality.
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Affiliation(s)
- Zhenghua Liang
- Intensive Care Unit, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan Province, China
| | - Qian Liao
- Gynecology and Obstetrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan Province, China
| | - Jinlong Xu
- Intensive Care Unit, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan Province, China
| | - Simei Wang
- Intensive Care Unit, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan Province, China
| | - Qiuyu Liu
- Intensive Care Unit, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan Province, China
| | - Zefang Liu
- Intensive Care Unit, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan Province, China
| | - Dan Wen
- Intensive Care Unit, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan Province, China.
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Joo DH, Park HC, Kim JH, Yang SH, Kim TH, Kim HJ, Song MJ, Lim SY, Kim SA, Bae HW, Ahn YH, Yoon SM, Park J, Lee HY, Lee J, Lee SM, Lee JC, Cho YJ. Clinical Efficacy and Safety of an Automatic Closed-Suction System in Mechanically Ventilated Patients with Pneumonia: A Multicenter, Prospective, Randomized, Non-Inferiority, Investigator-Initiated Trial. Diagnostics (Basel) 2024; 14:1068. [PMID: 38893595 PMCID: PMC11172224 DOI: 10.3390/diagnostics14111068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Endotracheal suctioning is an essential but labor-intensive procedure, with the risk of serious complications. A brand new automatic closed-suction device was developed to alleviate the workload of healthcare providers and minimize those complications. We evaluated the clinical efficacy and safety of the automatic suction system in mechanically ventilated patients with pneumonia. In this multicenter, randomized, non-inferiority, investigator-initiated trial, mechanically ventilated patients with pneumonia were randomized to the automatic device (intervention) or conventional manual suctioning (control). The primary efficacy outcome was the change in the modified clinical pulmonary infection score (CPIS) in 3 days. Secondary outcomes were the frequency of additional suctioning and the amount of secretion. Safety outcomes included adverse events or complications. A total of 54 participants, less than the pre-determined number of 102, were enrolled. There was no significant difference in the change in the CPIS over 72 h (-0.13 ± 1.58 in the intervention group, -0.58 ± 1.18 in the control group, p = 0.866), but the non-inferiority margin was not satisfied. There were no significant differences in the secondary outcomes and safety outcomes, with a tendency for more patients with improved tracheal mucosal injury in the intervention group. The novel automatic closed-suction system showed comparable efficacy and safety compared with conventional manual suctioning in mechanically ventilated patients with pneumonia.
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Affiliation(s)
- Dong-Hyun Joo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Hyo Chan Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Joon Han Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Seo Hee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Tae Hun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Hyung-Jun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Myung Jin Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Sung Yoon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Sung A Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
| | - Hee Won Bae
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
| | - Yoon Hae Ahn
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (Y.H.A.); (S.M.Y.); (H.Y.L.)
| | - Si Mong Yoon
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (Y.H.A.); (S.M.Y.); (H.Y.L.)
| | - Jimyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
| | - Hong Yeul Lee
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (Y.H.A.); (S.M.Y.); (H.Y.L.)
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (Y.H.A.); (S.M.Y.); (H.Y.L.)
| | - Jung Chan Lee
- Department of Biomedical Engineering, Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
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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; 26:839-845. [PMID: 36864859 PMCID: PMC9973182 DOI: 10.5005/jp-journals-10071-24252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction 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). Materials and 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) 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. 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). Discussion 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. How to cite this article 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.
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Affiliation(s)
- Sarvin Sanaie
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Sama Rahnemayan
- Research Center for Evidence-based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Sahar Javan
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Kamran Shadvar
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Seied-Hadi Saghaleini
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Ata Mahmoodpoor
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran,Ata Mahmoodpoor, Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran, Phone: +98 4133330049, e-mail:
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Lee YL, Liu KM, Chang HL, Lin JS, Kung FY, Ho CM, Lin KH, Chen YT. A dominant strain of Elizabethkingia anophelis emerged from a hospital water system to cause a three-year outbreak in a respiratory care center. J Hosp Infect 2020; 108:43-51. [PMID: 33157171 DOI: 10.1016/j.jhin.2020.10.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/02/2020] [Accepted: 10/29/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Elizabethkingia species are ubiquitous bacteria but uncommonly cause human infection. An outbreak of Elizabethkingia anophelis bacteraemia was observed in a respiratory care center of a tertiary hospital in Taiwan from 2015 to 2018. METHODS Clinical and environmental isolates were collected for the outbreak investigation. Pulsed-field gel electrophoresis (PFGE) and complete-genome sequencing were conducted to elucidate the mechanism of transmission. FINDINGS The three-year outbreak involved 26 patients with E. anophelis bacteraemia and the incidence significantly increased during the outbreak period compared with that observed from 2010 to 2014 (P<0.05). All 26 clinical isolates during the outbreak period belonged to a cluster by PFGE analysis. In contrast, the PFGE pattern was heterogeneous among comparative historical strains. Hospital tap water was highly contaminated by Elizabethkingia species (18/34, 52.9%); among that, five E. anophelis belonged to the outbreak cluster (5/18, 27.8%). As for the inanimate surface survey, 3.4% sites (4/117) revealed positive growth of E. anophelis including two from feeding tubes/bags and two from sputum suction regulators. All four isolates belonged to the outbreak clone. The outbreak strain had no apparent relationship to currently known E. anophelis strains worldwide through complete-genome sequencing analysis. Specific infection control strategies aimed at water source control and environmental disinfection were implemented subsequently and the outbreak ended in mid-2018. CONCLUSIONS A specific E. anophelis strain was identified from a three-year outbreak. The elucidation of the mechanism of dominance and intra-hospital transmission is crucial for development of corresponsive infection control policies and outbreak control.
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Affiliation(s)
- Y-L Lee
- Department of Internal Medicine, Changhua Christian Hospital, Changhua County, Taiwan; Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung City, Taiwan
| | - K-M Liu
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung City, Taiwan
| | - H-L Chang
- Department of Internal Medicine, Changhua Christian Hospital, Changhua County, Taiwan; Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung City, Taiwan
| | - J-S Lin
- Department of Laboratory Medicine, Changhua Christian Hospital, Changhua County, Taiwan
| | - F-Y Kung
- Department of Laboratory Medicine, Changhua Christian Hospital, Changhua County, Taiwan
| | - C-M Ho
- Department of Clinical Pathology and Laboratory Medicine, Taichung Tzu Chi Hospital, Taichung City, Taiwan
| | - K-H Lin
- Department of Clinical Pathology and Laboratory Medicine, Taichung Tzu Chi Hospital, Taichung City, Taiwan
| | - Y-T Chen
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung City, Taiwan; Biotechnology Center, National Chung Hsing University, Taichung City, Taiwan; Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli County, Taiwan.
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Harrois A, Anstey JR, Deane AM, Craig S, Udy AA, McNamara R, Bellomo R. Effects of Routine Position Changes and Tracheal Suctioning on Intracranial Pressure in Traumatic Brain Injury Patients. J Neurotrauma 2020; 37:2227-2233. [PMID: 32403976 DOI: 10.1089/neu.2019.6873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Patient position change and tracheal suctioning are routine interventions in mechanically ventilated traumatic brain injury (TBI) patients. We sought to better understand the impact of these interventions on intracranial pressure (ICP) and cerebral hemodynamics. We conducted a prospective study in TBI patients requiring ICP monitoring. The timing of position changes and suctioning episodes were recorded with concurrent blood pressure and ICP measurements. We collected data on 460 patient position changes and 204 suctioning episodes over 2404 h in 18 ventilated patients (mean age 34 [13] years, median Glasgow Coma Score 4 [3-7]). We recorded 24 (20-31) positioning and 11 (6-18) suctioning episodes per patient, with 54% and 39% of position changes associated with ICP ≥22 mm Hg and cerebral perfusion pressure (CPP) <60 mm Hg, respectively, and 22% and 27% of suctioning episodes associated with an ICP ≥22 mm Hg and CPP <60 mm Hg. The median change in ICP was 11 (6-16) mm Hg after position changes and 3 (1-9) mm Hg after suctioning. Reduction in CPP to <60 mm Hg lasted ≥10 min in 17% of positioning and 11% of suctioning episodes. The baseline ICP and its amplitude were both predictive of a rise in ICP ≥22 mm Hg after positioning and suctioning episodes, whereas cerebral autoregulation was not. Baseline CPP was predictive of a decrease in CPP <60 mm Hg after both interventions. Increases in ICP and reductions in CPP are common following patient positioning and tracheal suctioning episodes. Frequently, these changes are substantial and sustained.
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Affiliation(s)
- Anatole Harrois
- Intensive Care Unit, Level 5, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Anesthesia and Surgical Intensive Care, Paris Sud University, Orsay, France
| | - James R Anstey
- Intensive Care Unit, Level 5, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Adam M Deane
- Intensive Care Unit, Level 5, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Center for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Sally Craig
- Intensive Care Unit, Level 5, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Center, Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Intensive Care Unit, the Alfred Hospital, Melbourne, Victoria, Australia
| | - Robert McNamara
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Rinaldo Bellomo
- Intensive Care Unit, Level 5, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Center for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia.,Australian and New Zealand Intensive Care Research Center, Monash University, Melbourne, Victoria, Australia.,Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia
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John AO, Paul H, Vijayakumar S, Anandan S, Sudarsan T, Abraham OC, Balaji V. Mortality from acinetobacter infections as compared to other infections among critically ill patients in South India: A prospective cohort study. Indian J Med Microbiol 2020; 38:24-31. [PMID: 32719205 DOI: 10.4103/ijmm.ijmm_19_492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Acinetobacter baumannii has become a common pathogen causing hospital-acquired infections (HAIs). Although acquiring any nosocomial infection is associated with increased mortality, we do not know if the acquisition of Acinetobacter infection confers a worse prognosis as compared to non-Acinetobacter-related HAI. The aim of the current study is to compare the clinical outcomes of ventilator-associated pneumonia (VAP) and central line associated blood stream infections (CLABSIs) caused by A. baumannii with those caused by other bacterial pathogens. Materials and Methods This prospective cohort study was conducted among critically ill adults admitted to a tertiary care hospital in South India from January 2013 to June 2014. We enrolled patients who developed new-onset fever ≥48 h after admission and fulfilled pre-specified criteria for VAP or CLABSI. The patients were followed up until the primary outcomes of death or hospital discharge. Results During the study period, 4047 patients were admitted in the intensive care units, among which 129 eligible HAI events were analysed. Of these, 95 (73.6%) were VAP, 34 (26.4%) were CLABSI, 78 (60.4%) were A. baumannii-related HAI (AR-HAI) and 51 (39.6%) were non-A. baumannii-related HAI (NAR-HAI). Mortality among AR-HAI was 57.6% compared to 39.2% in NAR-HAI (P = 0.04) which on multivariate analysis did not achieve statistical significance, although the trend persisted (odds ratio [OR] = 4.2, 95% confidence interval [CI]: 0.95-18.4, P = 0.06). The acquisition of VAP due to A. baumannii was associated with poor ventilator outcomes even after adjusting for confounders (adjusted OR = 3.5, 95% CI: 1.07-11.6, P = 0.04). Conclusion In our cohort of critically ill adults with VAP and CLABSI, AR-HAI was associated with poor ventilator outcomes and a trend towards higher mortality. These findings add to the evidence suggesting that A. baumannii is a dangerous pathogen, perhaps even more so than others.
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Affiliation(s)
- Ajoy Oommen John
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Hema Paul
- Hospital Infection Control Committee, Christian Medical College, Vellore, Tamil Nadu, India
| | - Saranya Vijayakumar
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shalini Anandan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas Sudarsan
- Department of Medicine, Division of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India
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Letchford E, Bench S. Ventilator-associated pneumonia and suction: a review of the literature. ACTA ACUST UNITED AC 2019; 27:13-18. [PMID: 29323990 DOI: 10.12968/bjon.2018.27.1.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIM to identify the most effective suctioning technique for the prevention of ventilator-associated pneumonia. BACKGROUND ventilator-associated pneumonia is an important hospital-acquired infection associated with increased mortality and morbidity. METHOD a rapid review included an electronic database search of articles published between January 2009 and March 2016. The quality of the seven included studies was appraised and data were subjected to tabular and narrative syntheses. RESULTS closed suction systems have no clear advantage over open suction, but may better prevent late-onset ventilator-associated pneumonia. Subglottic secretion drainage reduces ventilator-associated pneumonia incidence. CONCLUSION open versus closed suction combined with subglottic secretion drainage requires ongoing research. Alongside this, policy guidance, education, behavioural and managerial strategies must be implemented.
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Affiliation(s)
- Emma Letchford
- Staff Nurse, Post-Anaesthetic Care Unit, Royal Brompton Hospital, London
| | - Suzanne Bench
- Associate Professor, School of Health and Social Care, London South Bank University
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Does open or closed endotracheal suction affect the incidence of ventilator associated pneumonia in the intensive care unit? A systematic review. ENFERMERIA CLINICA 2018. [DOI: 10.1016/s1130-8621(18)30179-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Khan MS, Karnam HF, Verma M. Accidental spillage of breathing circuit condensate into airway leading to ventilator-associated pneumonia. J Crit Care 2015; 30:646-7. [PMID: 25791767 DOI: 10.1016/j.jcrc.2015.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 01/28/2015] [Accepted: 02/18/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Mohd S Khan
- Department of Critical Care and Emergency Medicine, Pondicherry Institute of Medical sciences, Kalapet, Pondicherry, 605014, India.
| | - Hasan F Karnam
- Department of Critical Care and Emergency Medicine, Pondicherry Institute of Medical sciences, Kalapet, Pondicherry, 605014, India.
| | - M Verma
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Impact of closed versus open tracheal suctioning systems for mechanically ventilated adults: a systematic review and meta-analysis. Intensive Care Med 2014; 41:402-11. [PMID: 25425442 DOI: 10.1007/s00134-014-3565-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Whether closed tracheal suctioning systems (CTSS) reduce the incidence of ventilator-associated pneumonia (VAP) compared with open tracheal suctioning systems (OTSS) is inconclusive. We conducted a systematic review and meta-analysis of randomized controlled trials that compared CTSS and OTSS. METHODS PubMed, the Cochrane Central Register of Controlled Trials, the Web of Science, Google Scholar, and a clinical trial registry from inception to October 2014 were searched without language restrictions. Randomized controlled trials of CTSS and OTSS that compared VAP in mechanically ventilated adult patients were included. The primary outcome was the incidence of VAP. Secondary outcomes were mortality and length of mechanical ventilation. Data were pooled using the random effects model. RESULTS Sixteen trials with 1,929 participants were included. Compared with OTSS, CTSS was associated with a reduced incidence of VAP (RR 0.69; 95 % CI 0.54-0.87; Q = 26.14; I (2) = 46.4 %). Compared with OTSS, CTSS was not associated with reduction of mortality (RR 0.96; 95 % CI 0.83-1.12; Q = 2.27; I (2) = 0.0 %) or reduced length of mechanical ventilation (WMD -0.45 days; 95 % CI -1.25 to 0.36; Q = 6.37; I (2) = 5.8 %). Trial sequential analysis suggested a lack of firm evidence for 20 % RR reduction in the incidence of VAP. The limitations of this review included underreporting and low quality of the included trials, as well as variations in study procedures and characteristics. CONCLUSIONS Based on current, albeit limited evidence, it is unlikely that CTSS is inferior to OTSS regarding VAP prevention; however, further trials at low risk of bias are needed to confirm or refute this finding.
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