1MS in critical care nursing Sciences, School of Nursing and Midwifery, Lorestan University of medical sciences, Khoramabad, Iran
2Assistant Professor of nursing, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Lorestan University of medical sciences, Khoramabad, Iran
3Assistant Professor in Aesthesia, School of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran
4Assistant Professor in Community Medicine, School of Medicine, Lorestan University of medical sciences, Khoramabad, Iran
5Assistant Professor in Community Medicine, School of Medicine, Lorestan University of medical sciences, Lorestan, Iran
Background: If not done properly, suction causes complications such as hypoxia, cardiac arrhythmias or even death. Suction is being used in most hospital wards. Closed Suction appears to have fewer side effects, although studies have reported dissimilar results. Aim: The aim of this study was to compare the effect of open (control) with closed (test) endotracheal suctioning on patients’ Hemodynamic state. Methods: This study was a randomized clinical trial in 86 patients admitted in the ICU of Besat hospital of hamedan in 2013, being divided into two groups: open (control) and closed (test) endotracheal suctioning. Systolic and diastolic blood pressure, mean arterial pressure (MAP), heart rate, arterial O2 saturation (SPO2), respiratory rate and the incidence of disrrythmia were recorded in patients´ questionnaires immediately, and afterwards 2 and 5 minutes after endotracheal suctioning by open and closed methods. Data analysis was performed by Repeated Measure ANOVA, t test, chi-square and Fisher's exact test. Results: A total of 102 patients were included in the study. Sixteen patients were excluded from the study and data from 86 patients were analyzed. No statistically significant differences in age (15/0P =) and sex (33/0P =) were found between the two groups. Hemodynamics index in two groups was similar before the suctioning (P >0.05). In the open group, there was an increase in diastolic blood pressure (P=0.017), mean arterial pressure (P=0.019), heart rate (P=0.003) and respiratory rate (P<0.0001) immediately, 2 and 5 minutes after suctioning in comparison to the closed group (P>0.05). Systolic blood pressure, SPO2 and incidence of disrrythmia were similar in the two groups. Conclusion: Endotracheal suctioning by closed method had lower effects on patients´ Hemodynamic status rather than the open system. Hence, closed endotracheal suctioning is recommended in the ICU.
1. Vincent JL, Abraham E, Moore F, Fink M, Kochanek PM. Critical Care.6nd ed. Amsterdam: Elsevier Publishers; 2011.P.464-80.
2. Mandell G.L, Douglas R, Benntt J.E. Principles and Practices of Infectious Diseases. Volume 2, 7nd Ed, United States, Elsevier Publishers.2010, P.1750-65.
3. Richard D, Branson R. Secretion Management in the Mechanically Ventilated Patient. Respir Care2007; 52(10):1328-43.
4. Pagotto IM, Rogerio L, Oliveira C, Flavio C.Comparison between Open and Closed Suction Systems: A systematic review. Rev Bras Ter Intensiva 2008; 20(4): 331-8.
5. Irene P, Jongerden MS,Maroeska M,Rovers D, Mieke H, Marc J. Open and Closed Endotracheal Suction Systems in Mechanically Ventilated Intensive Care Patients: A meta-analysis.Crit Care Med 2007;35(1):260-70.
6. Nobahar M. Principle and Arts of Nursing. 1st ed. Tehran: Boshra; 2007. Pp.230-4. (Persian)
7.Deven J,Yash J, Omender S,Prashant N,Rameshwar P,Bhupesh U. Comparing Influence of Intermittent Subglottic Secretions Drainage with/without Closed Suction System on the Incidence of Ventilator-Associated Pneumonia.Indian J Crit Care Med 2011;15(3):168-72.
8. Arlene Coughlin. Let's Clear the Air about Suctioning. 2nd Ed, London, Lippincott: Williams & Wilkins. 2006, P. 135-40.
9. Subirana M, Solà I, Benito S. Closed Tracheal Suction Systems Versus Open Tracheal Suction Systems for Mechanically Ventilated Adult Patients. Lancet 2008:45(2):127-30.
10.Carsten M,Mette R,Jeanette H,Ingrid E. Endotracheal suctioning of the adult intubated patient- What is the evidence?Intensive and Crit Care Nursing 2009;25(1):21-30.
11. Phipps WJ, Monaham FD, Sand's JK. Medical Surgical Nursing; Health and Illness Prospective. 7th ed. Philadelphia, Mosby, 2011, P. 454-9.
12. Ruben D Joel M, John M. Endotracheal Suctioning of Mechanically Ventilated Patients with Artificial Airways 2010, American Association for Respiratory Care Clinical Practice Guidelines Steering Committee. Respir Care 2010; 55(6):758-64.
13. Heyland D, Mount Sinai. Hospital Critical Care Research - Current Studies VAP Study. Am J Respir Crit Care Med 1999; 159(4): 1249-56.
14. Ebrahimi Fakhar H, Rezai K, Kohestani H. Effect of Closed Endotracheal Suction on Incidence of Ventilator-Associated Pneumonia SJKU 2010; 15(2):79-87. (Persian)
15. Brendam, M.Closed-System Suctioning: Why is the Debate Still Open? Indian J Med Sci 2007; 61(4):177-8.
16. Powers J. Managing VAP Effectively to Optimize Outcomes and Costs. Nursing Management 2006; 37(1): 48-53.
17. Sole ML, Poalillo FE, Byers JF, Ludy JE. Bacterial Growth in Secretions and on Suctioning Equipment of Orally Intubated Patients: A Pilot Study. Am J Crit Care 2002; 11(2):141-9.
18. Woo Jung J, Hee Choi E, Hee Kim J, Kyung Seo J, Yeon Choi J. Comparison of a Closed With an Open Endotracheal Suction: Costs and the Incidence of Ventilator-associated Pneumonia .Tuberculosis and Respiratory Diseases 2008; 65(3):198-206.
19. Combes P, Fauvage B, and Oleyer C. Nosocomial Pneumonia in Mechanically Ventilated Patients: A Prospective Randomised Evaluation of the Stericath Closed Suctioning System. Intensive Care Med 2000; 26(7):878-82.
20. Nazmiyeh H, Mirjalili MR, Emami Maibodi R. Comparison of the Effect of Open and Closed Endotracheal Suction on Cardiovascular and Ventilation Parameters for Patients Undergoing Mecanichal Ventilation. Iran J Nurs Midwifery Res 2010:9(2):97-106. (Persian)
21. Zolfaghari M, Nikbakht Nasr Abadi A, Karimi Rezve A, Haghani H. The Open and Close Suctioning Effect on Patients’ Vital Sign. Hayat 2003:14(1):20-3. (Persian)
22. Jongerden IP, Rovers MM, Grypdonck MH, Bonten MJ. Open and Closed Endotracheal Suction Systems in Mechanically Ventilated Intensive Care Patients: a Meta-Analysis. Crit Care Med2007; 35(1): 260-70.
23. Asgari M.Critical Nursing Care in CCU, ICU and Dialysis. 9st ed. Tehran: Boshra; 2005.Pp.242-5. (Persian)
24. Kalyn A, Blatz S, Sandra Feuerstake , Paes B, Bautista C. Closed Suctioning of Intubated Neonates Maintains Better Physiologic Stability: A Randomized Trial. J Perinatol 2003; 23(3): 218-22.
25. Seyyed Mazhari M., Pishgou’ei A. H., Zareian A., Habibi H. Effect of Open and Closed Endotracheal Suction Systems on Heart Rhythm and Artery Blood Oxygen Level in Intensive Care Patients. IJCCN. 2010; 2 (4):1-2. (Persian)
26.Lasocki S, Lu Q, Sartorius A, Fouillat D, Remerand F, Rouby JJ. Open and Closed-Circuit Endotracheal Suctioning in Acute Lung Injury: Efficiency and Effects on Gas Exchange. Anesthesiology 2006; 104(1): 39-47.