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Ventilator-associated pneumonia with a closed versus an open endotracheal suction system


To analyze the incidence of ventilator-associated pneumonia (VAP) with a closed endotracheal suction system (CESS) versus an open endotracheal suction system (OESS).


A prospective study during 9 months. Included were all patients who required mechanical ventilation for 12 hours or more. At admission to the ICU patients were randomized into two groups: one group was suctioned with CESS, and another group with OESS. VAP was defined according to the following criteria: a chest radiographic examination showing new or progressive infiltrate; new onset of purulent sputum; significant quantitative culture of pathogen from respiratory secretions (tracheal aspirate > 106 cfu/ml, bronchoalveolar lavage > 104 cfu/ml or protected bronchial brush catheter > 103 cfu/ml). The statistical analysis was realized by the chi-square test and the Student t test, and we took P < 0.05 to consider a significant difference.


Included were 230 patients (62% male). The mean age was 58.2 ± 17.23 years, APACHE II score was 14.38 ± 6.41, mortality was 14.92%. The patient distribution was: 50% cardiac surgery, 9% cardiologic, 7% respiratory, 4% digestive, 10% neurologic, 11% traumathology, 3% intoxication, 6% abdominal sepsis. Both groups of patients (114 with CESS and 116 with OESS) were similar in age, sex, diagnosis groups, mortality and APACHE II score. No significant diferences were found in the percentage of patients who developed ventilator-associated pneumonia in global (13.79% vs 14.28%) and by period of mechanical ventilation time, nor in the number of ventilator-associated pneumonia per 1000 mechanical ventilation-days in global (15.85 vs 16.12) and by period of mechanical ventilation time. No differences were observed in microorganism responsibles of VAP. Neither were there found any differences in the incidence of exogenous VAP (2.79% vs 2.48%).


We conclude that in our series, the CTSS did not reduce the ventilator-associated pneumonia incidence, nor the exogenous pneumonia.

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Lorente, L., Lecuona, M., García, C. et al. Ventilator-associated pneumonia with a closed versus an open endotracheal suction system. Crit Care 8 (Suppl 1), P211 (2004).

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