Dong Liang, Yu Tao, Yang Yi, Qiu Hai-bo
Department of Critical Medicine, Zhongda Hospital and School of Clinical Medicine, Southeast University, Nanjing 210009, China.
Zhonghua Nei Ke Za Zhi. 2012 Oct;51(10):763-8.
To evaluate the effects and safety of closed tracheal suction system(CTSS) versus open tracheal suction system (OTSS) for mechanically ventilated patients.
All randomized controlled trials (RCTs) comparing CTSS with OTSS for mechanically ventilated patients home and abroad were identified via manual and computer retrieval. All related data were extracted. Meta analysis was conducted using the statistical software RevMan 5.1 on the basis of strict quality evaluation with the methods recommended by the Cochrane Collaboration.
Fifty-one related papers were found and 12 RCTs involving 1205 patients in CTSS group and 1179 patients in OTSS group were included. The results of meta analysis showed that CTSS was associated with a significant reduction in the duration of mechanical ventilation (WMD = -0.73, 95%CI -1.07 - -0.40, P < 0.0001), but the incidence of ventilator associated pneumonia and microbial colonization, mortality and length of ICU stay exhibited no difference between the two groups (P > 0.05). However, compared with OTSS, CTSS reduced the incidence of arrhythmia (RR = 0.23, 95%CI 0.07 - 0.74, P = 0.01) and minimized the disturbance to heart rate (WMD = -1.97, 95%CI -3.03 - -0.91, P = 0.0003), mean arterial pressure (WMD = -2.01, 95%CI -3.02 - -1.01, P < 0.0001) and oxygen saturation (SpO2) (WMD = -1.00, 95%CI -1.14 - -0.86, P < 0.000 01).
Compared with OTSS, CTSS could reduce disturbance to respiratory and circulatory system by sputum suction and shorten the duration of mechanical ventilation. However, CTSS has no advantage in prevention of ventilator associated pneumonia or microbial colonization, nor does it shorten the length of ICU stay or improve the outcome of mechanically ventilated patients.
评估密闭式气管吸痰系统（CTSS）与开放式气管吸痰系统（OTSS）应用于机械通气患者的效果及安全性。
通过手工检索和计算机检索，查找国内外所有比较CTSS与OTSS用于机械通气患者的随机对照试验（RCT）。提取所有相关数据。依据Cochrane协作网推荐的方法进行严格质量评估后，使用统计软件RevMan 5.1进行Meta分析。
共检索到51篇相关文献，纳入12项RCT，其中CTSS组1205例患者，OTSS组1179例患者。Meta分析结果显示，CTSS可显著缩短机械通气时间（加权均数差[WMD]= -0.73，95%可信区间[CI] -1.07至-0.40，P<0.0001），但两组在呼吸机相关性肺炎和微生物定植发生率、死亡率及ICU住院时间方面无差异（P>0.05）。然而，与OTSS相比，CTSS可降低心律失常发生率（风险比[RR]=0.23，95%CI 0.07至0.74，P=0.01），并使心率（WMD= -1.97，95%CI -3.03至-0.91，P=0.0003）、平均动脉压（WMD= -2.01，95%CI -3.02至-1.01，P<0.0001）和血氧饱和度（SpO2）（WMD= -1.00，95%CI -1.14至-0.86，P<0.00001）的干扰最小化。
与OTSS相比，CTSS吸痰时对呼吸和循环系统的干扰更小，可缩短机械通气时间。然而，CTSS在预防呼吸机相关性肺炎或微生物定植方面无优势，也不能缩短ICU住院时间或改善机械通气患者的预后。
