Department of Medicine II, Christian Medical College & Hospital, Vellore, 632004, Tamil Nadu, India.
Department of Biostatistics, Christian Medical College and Hospital, Vellore, India.
J Crit Care. 2011 Oct;26(5):482-488. doi: 10.1016/j.jcrc.2010.10.002. Epub 2010 Nov 23.
Closed endotracheal suctioning (CES) may impact ventilator-associated pneumonia (VAP) risk by reducing environmental contamination. In developing countries where resource limitations constrain the provision of optimal bed space for critically ill patients, CES assumes greater importance.
In this prospective, open-labeled, randomized controlled trial spanning 10 months, we compared CES with open endotracheal suctioning (OES) in mechanically ventilated patients admitted to the medical intensive care unit (ICU) of a university-affiliated teaching hospital. Patients were followed up from ICU admission to death or discharge from hospital. Primary outcome was incidence of VAP. Secondary outcomes included mortality, cost, and length of stay.
Two hundred patients were recruited, 100 in each arm. The incidence of VAP was 23.5%. Closed endotracheal suctioning was associated with a trend to a reduced incidence of VAP (odds ratio, 1.86; 95% confidence interval, 0.91-3.83; P = .067). A significant benefit was, however, observed with CES for late-onset VAP (P = .03). Mortality and duration of ICU and hospital stay were similar in the 2 groups. The cost of suction catheters and gloves was significantly higher with CES (Rs 272 [US $5.81] vs Rs 138 [US $2.94], P < .0001). Nine patients need to be treated with CES to prevent 1 VAP (95% confidence interval, -0.7 to 22).
In the ICU setting in a developing country, CES may be advantageous in reducing the incidence of VAP, particularly late-onset VAP. These results mandate further studies in this setting before specific guidelines regarding the routine use of CES are proposed.
通过减少环境污染，密闭式吸痰（CES）可能会降低呼吸机相关性肺炎（VAP）的风险。在资源有限、无法为危重症患者提供最佳床位的发展中国家，CES 的重要性更为凸显。
本前瞻性、开放标签、随机对照试验历时 10 个月，对比了机械通气患者在入住大学附属医院的重症监护病房（ICU）时行 CES 与开放式吸痰（OES）的效果。患者从 ICU 入院起进行随访，直至死亡或出院。主要结局为 VAP 的发生率。次要结局包括死亡率、费用和住院时间。
共纳入 200 例患者，每组 100 例。VAP 的发生率为 23.5%。CES 与 VAP 发生率降低呈趋势相关（比值比，1.86；95%置信区间，0.91-3.83；P=0.067）。然而，CES 对迟发性 VAP 有显著获益（P=0.03）。两组死亡率以及 ICU 和住院时间无显著差异。CES 的吸痰管和手套费用明显更高（Rs272[5.81 美元] vs Rs138[2.94 美元]，P<0.0001）。为预防 1 例 VAP，需治疗 9 例患者（95%置信区间，-0.7 至 22）。
在发展中国家的 ICU 环境中，CES 可能有利于降低 VAP 的发生率，尤其是迟发性 VAP。这些结果提示，在提出 CES 常规使用的具体指南之前，还需在该环境中进行进一步的研究。
