Ramírez-Torres Carmen Amaia, Rivera-Sanz Félix, Sufrate-Sorzano Teresa, Pedraz-Marcos Azucena, Santolalla-Arnedo Ivan
Health and Care Research Group, University of La Rioja, Logroño, Spain.
Research Unit on Health System Sustainability, Biomedical Center of La Rioja, Logroño, Spain.
Interact J Med Res. 2023 Jan 10;12:e42549. doi: 10.2196/42549.
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.
2020年重症监护病房（ICU）收治人数的增加以及与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染相关的发病率和死亡率，对ICU中实施的健康干预措施的证据分析构成了挑战。对于感染该病毒并入住ICU的患者，最常见的干预措施之一是气管内抽吸。气管内吸痰也被认为是污染性最强的干预措施之一。
本综述旨在分析在新型冠状病毒肺炎（COVID-19）患者中使用密闭吸痰系统（CSS）进行气管内吸痰的益处和风险。
使用以下数据库进行快速综述：PubMed、MEDLINE、护理学与健康领域数据库（CINAHL）、拉丁美洲和加勒比卫生科学数据库（LILACS）、考克兰图书馆和西班牙健康科学与护理数据库（IBECS）。数据检索包括2010年至2020年间发表的、涉及成年患者、使用关键词“气管内”“吸痰”和“密闭系统”的英文和西班牙文文章。
共纳入15篇文章。益处和风险分为3类：患者、护理和组织。在患者方面，我们发现心肺变量和呼吸机存在差异，例如，因适应不良和肺泡萎陷导致呼气末正压升高的患者情况有所改善。在护理方面，我们发现吸痰时间缩短，最多可缩短1分钟。在组织方面，我们发现医护人员手套上的微生物减少。研究之间的其他相互矛盾的结果与呼吸机相关性肺炎、细菌定植或死亡率有关。
除了需要进行高质量研究以比较用于治疗COVID-19患者的开放吸痰系统和CSS外，密闭式气管内吸痰在缩短ICU住院时间和减少环境污染方面具有益处，可防止呼吸机与患者断开连接，减少吸痰时间（尽管它确实会导致最多的黏膜阻塞），并防止患者之间以及患者与医护人员之间的环境污染。为了比较结果并制定新的指南，需要在SARS-CoV-2病毒背景下获取新的证据。
