Background & Aim: Although trachea-bronchial suctioning (TBS) is one of the important nursing procedures in intensive care units (ICU), it may be associated with some complications. Using closed system suctioning (CSS) is one of the ways to decrease the rate of complications due to continued ventilation and oxygenation at the time of suctioning. However, CSS' secretion removal is not efficient enough. Higher values of suction pressure have been recommended to enhance the efficacy of CSS. The aim of this study was to compare the efficacy of two levels of negative suction pressure in secretion removal of CSS used for mechanically ventilated (MV) patients. Materials & Methods: Fifty eligible adult MV patients (twenty in each group) with Random allocation participated in this clinical trial study with cross-over design. Each patient was suctioned using CSS, connected to a central suction device, with 100 and 200 mmHg pressures with a two-hour interval. Efficacy of suctioning was measured by the absence of secretion flow at the end of suctioning. Volume of the secretions was measured and compared in each suctioning. Statistical analyses were done using Minitab and SPSS software considering the significance level of 0. 05. Results: CSS using 200 mmHg resulted in an efficacy of 96% for removing secretions, compared to 34% for 100 mmHg (P = <0. 0001). Suctioning volume was increased significantly higher with 200 mmHg suction pressure compared to values with 100 mmHg (1. 72 [95% confidence interval (CI): 1. 4; 2. 0]; P<0. 0001). Conclusion: Application of CSS with Suctioning pressure 200 mmHg is recommended for trachea-bronchial suctioning in mechanically ventilated patients, because nearly complete removal of respiratory suctioning in most subjects.

Background: Painful care procedures are the most common cause of stress in patients admitted to Intensive Care Units (ICUs). Tracheal suctioning is the most painful experience for ICU patients. The present study was conducted to compare open and closed endotracheal suctioning in terms of their effect in pain in mechanically ventilated patients. Materials and Methods: The present clinical trial recruited 70 mechanically ventilated patients with tracheostomy in 2019. The eligible patients were randomly divided into open and closed suctioning groups. The pain was measured in the patients using the Critical Pain Observational Tool (CPOT) before and during suctioning as well as 10 and 30 min later. The data were analyzed using the repeated measures Analysis Of Variance (ANOVA), paired t‑ test, and Chi‑ squared test. Results: The pain score was significantly higher in the open suctioning group during (t = 2. 59, p = 0. 01) and 10 min after suctioning (t = 3. 02, p = 0. 004). No significant differences were observed in the pain score between the two groups 30 min after suctioning (t = 0. 32, p = 0. 75). The post hoc Least Significant Difference (LSD) test showed that the CPOT scores 10 min after suctioning was significantly higher than that before suctioning and significantly lower than that during suctioning (p = 0. 001). The CPOT score 30 min after suctioning was also significantly lower than that 10 min after suctioning (p < 0. 001). Conclusions: The present findings suggested a lower pain in the patients with closed suctioning compared to those with open suctioning.

Background: Endotracheal suctioning (ETS) is an essential procedure performed for mechanically ventilated patients. ETS can be either performed by open or closed suctioning system (CSS). There may be some concern on how closed-system ETS is practiced by intensive care nurses. This study was designed to investigate closed-system ETS practices of critical care nurses and to compare their practice with standard recommendations.Materials and Methods: A prospective observational study was conducted during August and December 2012 to establish how critical care nurses (N=40) perform different steps in a typical ETS practice and to compare it with the current best practice recommendations through a 23-item structured checklist. The results were categorized into three sections: Pre-suctioning, suctioning, and post-suctioning practices.Results: Pre-suctioning, suctioning, and post-suctioning practices mean scores were 7.5, 11.75, and 8.5, respectively, out of 16, 16, and 12, respectively. The total suctioning practice score was 27.75 out of 44. Most discrepancies were observed in the patients’ assessment and preparation, infection control practices, and use of an appropriate catheter. Spearman correlation coefficient indicated a significant statistical positive correlation between suctioning education period and suctioning practice score (P<0.0001) and between working experience and suctioning practice score (P=0.02).Conclusions: The findings revealed that critical care nurses do not fully adhere to the best practice recommendation in CSS. We recommend that standard guidelines on ETS practice be included in the current education of critical care nurses.

Background: Critically ill patients under mechanical ventilation require frequent suctioning of airway secretion. Closed suction permits suctioning without disconnection from ventilator; so it might decrease hypoxemia and infection rate.Objectives: This study aimed to evaluate t he effect of closed tracheal suction system (CTSS) versus open tracheal suction system (OTSS).Patients and Methods: This is a prospective randomized study, which was carried on 100 patients in surgical Intensive Care Unit requiring mechanical ventilation for more than 48 hours from June 2012 to November 2013. In two groups, suction was performed based on the patients' need as well as physician's or nurses' decision on tracheal secretions. Patients randomly allocated into two groups (50 patients each): CTSS group and OTSS group. Patients were monitored for developing ventilator-associated pneumonia (VAP) during the study. Throat samples were taken on admission and two times per week from each patient. Tracheal samples were performed during endotracheal intubation, two times per week during mechanical ventilation and during extubation.Results: Drainage of subglottic secretions decreased the incidence of VAP (P<0.05). Also type of the pharmacologic medicine for stress ulcer prophylaxis has significant effect on VAP incidence. Among the patients in OTSS and CTSS groups, 20% and 12% developed VAP, respectively. Use of CTSS compared with OTSS did not show statistically significant effect on VAP incidence in multivariate analysis; however, OR (odds ratio) tended to identify OTSS as an exposure factor for the development of VAP (OR=1.92; CI=0.45-8.30; =0.38) compared with the CTSS. Higher levels of APACHE II score, sinusitis and tracheostomy put the patients at the risk of VAP. However, using heat and moisture exchanger (HME) instead of humidifier decreased this risk.Conclusions: Based on the results obtained from our study, impact of suctioning is similar between CTSS and OTSS regarding the occurrence of VAP. It seems that physicians must consider many factors such as duration of mechanical ventilation, comorbidities, oxygenation parameters, number of required suctioning, and the cost prior to using each type of tracheal suction system.

Aims: Mechanical ventilation is used for some infants in neonatal intensive care units (NICU) due to many physiological and clinical causes. Since these patients have endotracheal tubes, cleaning and keeping the airways open through suctioning should be done to increase oxygenation. This study aimed to evaluate effect of open and closed suctioning methods on respiratory parameters of infants undergoing mechanical ventilation.Materials and Methods: In this crossover clinical trial, 44 infants were selected among those undergone mechanical ventilation in NICU of Isfahan’s Al-Zahra Hospital using convenience sampling method. The subjects were randomly divided into two groups. In the first group, open suctioning was carried out and after three hours of cleaning, closed suctioning was done. In the second group, closed suctioning was firstly done and following three hours of cleaning, open suctioning was implemented. Respiratory rate (RR) and percentage of arterial blood oxygen saturation was measured before, during and after each type of suctioning. Data were analyzed using repeated measures ANOVA and independent student’s t-test.Findings: There was a significant difference between mean respiratory rate and arterial blood oxygen saturation in infants before, during and after the closed and open suctioning. The percentage of arterial blood oxygen saturation had a significant reduction in open method compared to closed method during suctioning and immediately after it. RR three minutes after suctioning showed a significant reduction in both steps in open method compared to closed method.Conclusions: Close method caused fewer changes in hemodynamic status of infants. Therefore, in order to prevent respiratory complications in infants, nurses are recommended to perform the endotracheal tube suctioning by closed method.