EFFECTIVENESS OF PNEUMONIA PREVENTION IN CONNECTIVE PNEUMONIA RELATED TO MECHANICAL VENTILATION WITH CLOSED SUCTION SYSTEMS IN PATIENTS WITH CRANIAL TRAUMA
Main Article Content
Abstract
Background: Ventilator-associated pneumonia (VAP) is a common complication in patients with traumatic brain injury (TBI), contributing to increased treatment burden. Endotracheal suctioning is an essential procedure but may induce physiological disturbances and increase infection risk if not properly performed. Closed suction systems are expected to mitigate these disadvantages.
Objective: To evaluate the effectiveness of VAP prevention, adverse effects, and economic efficiency of the closed suction system in mechanically ventilated TBI patients.
Methods: A prospective, controlled interventional study was conducted on 101 TBI patients requiring mechanical ventilation for ≥48 hours. Patients were divided into two groups: closed suction (n=52) and open suction (n=49). Outcome measures included VAP incidence and onset timing, clinical progression, changes in SpO₂, suction-related complications, and economic efficiency.
Results: The closed suction group showed a significantly lower VAP incidence compared to the open suction group (34.6% vs. 55.1%; p<0.05) and a delayed onset of pneumonia. During suctioning, SpO₂ remained more stable and the incidence of atelectasis was significantly reduced in the closed suction group. No significant differences were observed between groups regarding causative pathogens, duration of mechanical ventilation, or ICU length of stay. The daily suction-related cost per ventilated patient was lower in the closed suction group.
Conclusion: The closed suction system is effective in preventing VAP, minimizing physiological disturbances during suctioning, and providing economic benefits in mechanically ventilated TBI patients. This method should be prioritized in critical care practice.
Article Details
Keywords
Ventilator-associated pneumonia; closed suction system; traumatic brain injury; intensive care.
References
2. David D SP, David T, Keshava SN, Irodi A, Peter JV. An open-labelled randomized controlled trial comparing costs and clinical outcomes of open endotracheal suctioning with closed endotracheal suctioning in mechanically ventilated medical intensive care patients. J Crit Care. 2011;26(5):482-8.
DOI: 10.1016/j.jcrc.2010.10.002
3. Quỳnh ĐD. Đặc điểm lâm sàng viêm phổi liên quan đến thở máy ở bệnh nhân chấn thương và mức độ kháng kháng sinh của vi khuẩn gây bệnh 2019.
4. Kuriyama A, Umakoshi N, Fujinaga J, Takada T. Impact of closed versus open tracheal suctioning systems for mechanically ventilated adults: a systematic review and meta-analysis. Intensive care medicine. 2015;41(3):402-11. DOI: 10.1007/s00134-014-3565-4
5. Alipour N, Manouchehrian N, Sanatkar M, Anvari HMP, Jahromi MSS. Evaluation of the effect of open and closed tracheal suction on the incidence of ventilator associated pneumonia in patients admitted in the intensive care unit. Archives of Anesthesiology and Critical Care. 2016;2(2):193-6.
6. Povoa P, Coelho L, Almeida E, Fernandes A, Mealha R, Moreira P, et al. C-reactive protein as a marker of ventilator-associated pneumonia resolution: a pilot study. European Respiratory Journal. 2005;25(5):804-12. DOI: 10.1183/09031936.05.00071704
7. Ishimine N, Honda T, Yoshizawa A, Kawasaki K, Sugano M, Kobayashi Y, et al. Combination of White Blood Cell Count and Left Shift Level Real‐Timely Reflects a Course of Bacterial Infection. Journal of clinical laboratory analysis. 2013;27(5):407-11.
DOI: 10.1002/jcla.21619
8. Elmelegy OEA, Ahmed R. Effect of open versus closed endotracheal suctioning system on vital signs among mechanically ventilated patients in ICU. Journal of Nursing and Health Science. 2016;5(6):91-100.
9. Grott K, Chauhan S, Dunlap JD. Atelectasis. 2019.
10. Kiền ĐQ. Đánh giá hiệu quả phương pháp hút đờm kín trong chăm sóc bệnh nhân thở máy tại khoa điều trị tích cực - chống độc bệnh viện đa khoa tỉnh Thái Bình. 2018.
11. Jeong J-H, Nam S-J, Cho Y-J, Lee YJ, Kim SJ, Song I-A, et al. A closed-suction catheter with a pressure valve can reduce tracheal mucosal injury in intubated patients. The Korean Journal of Critical Care Medicine. 2014;29(1):7-12. DOI: https://doi.org/10.4266/kjccm.2014.29.1.7