The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Login
EN
+7 (495) 482-4118
+7 (495) 482-0604
+8 800 101-59-87
  • (toll-free number for subscriptions)
    Mon-Fri from 10 a.m. to 6 p.m.

  • © 1998-2025
+7 (495) 482-43-29
EN
All journals
Journal
Year
Year
Search result: 0

Lapin K.S.

Severodvinsk City Clinical Hospital No. 2

Kuzkov V.V.

Severodvinsk City Clinical Hospital No. 2;
Northern State Medical University

Chernova T.V.

Severodvinsk City Clinical Hospital No. 2

Galkina T.V.

Severodvinsk City Clinical Hospital No. 2

Kirov M.Yu.

Northern State Medical University

Impact of closed suction system on the incidence of ventilator-associated pneumonia, patient colonization and contamination of inanimate surfaces

Authors:

Lapin K.S., Kuzkov V.V., Chernova T.V., Galkina T.V., Kirov M.Yu.

More about the authors

Journal: Russian Journal of Anesthesiology and Reanimatology. 2020;(4): 32‑41

DOI: 10.17116/anaesthesiology202004132

Views: 2514

Downloaded: 116

Download PDF (RU)
Contact the author
Table of contents

To cite this article:

Lapin KS, Kuzkov VV, Chernova TV, Galkina TV, Kirov MYu. Impact of closed suction system on the incidence of ventilator-associated pneumonia, patient colonization and contamination of inanimate surfaces. Russian Journal of Anesthesiology and Reanimatology. 2020;(4):32‑41. (In Russ.)
https://doi.org/10.17116/anaesthesiology202004132

Подписка 2025 (АиР)
МСФ на ЯМ
Close metadata

OBJECTIVE

To assess the effect of closed suction systems on the incidence and timing of ventilator-associated pneumonia (VAP), colonization of oropharynx, trachea and surrounding inanimate surfaces and clinical outcomes within 96 hours of mechanical ventilation.

MATERIAL AND METHODS

A prospective randomized pilot study included 40 adults aged 18—80 years. All patients required mechanical ventilation for at least 48 hours. The diagnosis of VAP was confirmed using Clinical Pulmonary Infection Score (CPIS) ≥6 points. Patients were randomized into two groups: the control group of open suction of tracheal secretion (OS, n=20) and the closed suction group (CS, n=20). The common VAP prevention measures were realized in both groups.

RESULTS

The overall incidence of VAP in both groups was 30% (n=12). VAP was diagnosed in 45% (n=9) and 5% (n=3) of patients, respectively (p=0.048). Early VAP (within 48—96 hours) was registered in 5 patients in the OS group and in 3 patients in the CS group, whereas delayed VAP (after 96 hours) was observed in the OS group only (n=4). In the CS group, we have found significantly higher rate of oropharyngeal Candida spp. contamination at 48 hours (p=0.013). K. pneumoniae predominated among the causative microorganisms of early VAP in the CS group (67%), and Str. pneumoniae was the key causative agent in the OS group (40%). In the OS group, the most common microorganism for the late VAP was E. coli (75%). SOFA score at 48 hours was significantly lower in the CS group.

CONCLUSIONS

Closed suction of respiratory secretions within 96 hours of mechanical ventilation is associated with reduced incidence of VAP (first of all, late forms) and attenuation of multiple organ dysfunction.

Keywords:

ventilator-associated pneumonia
infection control
isolated patient
closed suction systems
epidemiologic control

Authors:

Lapin K.S.

Severodvinsk City Clinical Hospital No. 2

Kuzkov V.V.

Severodvinsk City Clinical Hospital No. 2;
Northern State Medical University

Chernova T.V.

Severodvinsk City Clinical Hospital No. 2

Galkina T.V.

Severodvinsk City Clinical Hospital No. 2

Kirov M.Yu.

Northern State Medical University

Received:

09.04.2020

Accepted:

19.04.2020

List of references:

  1. Carson SS, Cox CE, Holmes GM, Howard A, Carey TS. The changing epidemiology of mechanical ventilation: a population-based study. Journal of Intensive Care Medicine. 2006;21(3):173-182.  https://doi.org/10.1177/0885066605282784
  2. Alecrim RX, Taminato M, Belasco A, Longo MCB, Kusahara DM, Fram D. Strategies for preventing ventilator-associated pneumonia: an integrative review. Revista Brasileira de Enfermagem. 2019;72(2):521-530.  https://doi.org/10.1590/0034-7167-2018-0473
  3. Yilmaz M, Gajic O. Optimal ventilator settings in acute lung injury and acute respiratory distress syndrome. European Journal of Anaesthesiology. 2008;25(2):89-96.  https://doi.org/10.1017/S0265021507003006
  4. Klompas M, Khan Y, Kleinman K, Evans RS, Lloyd JF, Stevenson K, Samore M, Platt R; CDC Prevention Epicenters Program. Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation. PLoS One. 2011;6(3):1-7.  https://doi.org/10.1371/journal.pone.0018062
  5. Kallet RH. Patient-ventilator interaction during acute lung injury, and the role of spontaneous breathing: part 1: respiratory muscle function during critical illness. Respiratory Care. 2011;56(2):181-189.  https://doi.org/10.4187/respcare.00964
  6. Repessé X, Charron C, Vieillard-Baron A. Acute cor pulmonale in ARDS: rationale for protecting the right ventricle. Chest. 2015;147(1):259-265.  https://doi.org/10.1378/chest.14-0877
  7. Pettenuzzo T, Fan E. 2016 year in review: mechanical ventilation. Respiratory Care. 2017;62(5):629-635.  https://doi.org/10.4187/respcare.05545
  8. Craven DE, Hjalmarson KI. Ventilator-associated tracheobronchitis and pneumonia: thinking outside the box. Clinical Infectious Diseases: an Official Publication of the Infectious Diseases Society of America. 2010;51(1):59-66.  https://doi.org/10.1086/653051
  9. Ferrer M, Sequeira T, Cilloniz C, Dominedo C, Bassi GL, Martin-Loeches I, Torres A. Ventilator-associated pneumonia and PaO2/FiO2 diagnostic accuracy: changing the paradigm? Journal of Clinical Medicine. 2019;8:1217. https://doi.org/10.3390/jcm8081217
  10. Diaconu O, Siropol I, Polosanu LL, Grigoraș I. Endotracheal tube biofilm and its impact on the pathogenesis of ventilator-associated pneumonia. Journal of Critical Care Medicine. 2018;4(2):50-55.  https://doi.org/10.2478/jccm-2018-0011
  11. Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respiratory Care. 2005;50(6):725-739. 
  12. Shi Y, Huang Y, Zhang TT, Cao B, Wang H, Zhuo C, Ye F, Su X, Fan H, Xu JF, Zhang J, Lai GX, She DY, Zhang XY, He B, He LX, Liu YN, Qu JM. Chinese guidelines for the diagnosis and treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in adults (2018 edition). Journal of Thoracic Disease. 2019;11(6):2581-2616. https://doi.org/10.21037/jtd.2019.06.09
  13. Huang WM, Huang XA, Du YP, Li LX, Wu FF, Hong SQ, Tang FX, Ye ZQ. Tapered cuff versus conventional cuff for ventilator-associated pneumonia in ventilated patients: a meta-analysis of randomized controlled trials. Canadian Respiratory Journal. 2019;7876417. https://doi.org/10.1155/2019/7876417
  14. Álvarez Lerma F, Sánchez García M, Lorente L, Gordo F, Añón JM, Álvarez J, Palomar M, García R, Arias S, Vázquez-Calatayud M, Jam R; Sociedad Española de Medicina Intensiva; Sociedad Española de Enfermería Intensiva. Guidelines for the prevention of ventilator-associated pneumonia and their implementation. the Spanish «zero-VAP» bundle. Medicina Intensiva. 2014;38(4):226-236.  https://doi.org/10.1016/j.medin.2013.12.007
  15. Frederickson TA, Peno SM, Jackson JA, Renner CH, Sahr SM. Assessment of the implementation of a protocol to reduce ventilator-associated pneumonia in intensive care unit trauma patients. The Journal of Trauma Nursing. 2013;20(3):133-138.  https://doi.org/10.1097/JTN.0b013e3182a171e3
  16. Eom JS, Lee MS, Chun HK, Choi HJ, Jung SY, Kim YS, Yoon SJ, Kwak YG, Oh GB, Jeon MH, Park SY, Koo HS, Ju YS, Lee JS. The impact of a ventilator bundle on preventing ventilator-associated pneumonia: a multicenter study. American Journal of Infection Control. 2014;42(1):34-37.  https://doi.org/10.1016/j.ajic.2013.06.023
  17. Rodrigues AN, Fragoso LVEC, Beserra F, Ramos IC. Determining impacts and factors in ventilator-associated pneumonia bundle. Revista Brasileira de Enfermagem. 2016;69(6):1108-1114. https://doi.org/10.1590/0034-7167-2016-0253
  18. Timsit JF, Esaied W, Neuville M, Bouadma L, Mourvllier B. Update on ventilator-associated pneumonia. F1000Res. 2017;6(0):1-13.  https://doi.org/10.12688/f1000research.12222.1
  19. Oliveira J, Zagalo C, Cavaco-Silva P. Prevention of ventilator-associated pneumonia. Revista Portuguesa De Pneumologia. 2014;20(3):152-161.  https://doi.org/10.1016/j.rppneu.2014.01.002
  20. Dexter AM, Scott JB. Airway management and ventilator associated events. Respiratory Care. 2019;64(8):986-993.  https://doi.org/10.4187/respcare.07107
  21. Muscedere J, Dodek P, Keenan S, Fowler R, Cook D, Heyland DK. Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: prevention. Journal of Critical Care. 2008; 23:126-137.  https://doi.org/10.1016/j.jcrc.2007.11.014
  22. Hlinková E, Nemcová J, Bielená K. Closed versus open suction system of the airways in the prevention of infection in ventilated patients. Central European Journal of Nursing and Midwifery. 2014;5(2):63-71. 
  23. Subirana M, Solà I, Benito S. Closed tracheal suction systems versus open tracheal suction systems for mechanically ventilated adult patients (review). The Cochrane Database of Systematic Reviews. 2007;4:CD004581. https://doi.org/10.1002/14651858
  24. Letchford E, Bench S. Ventilator-associated pneumonia and suction: a review of the literature. British Journal of Nursing. 2018;27(1):13-18.  https://doi.org/10.12968/bjon.2018.27.1.13
  25. David D, Samuel P, 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 inmechanically ventilated medical intensive care patients. Journal of Critical Care. 2011;26(5):482-488.  https://doi.org/10.1016/j.jcrc.2010.10.002
  26. Maggiore SM, Taille S, Deye N, Durrmeyer X, Richard J, Mancebo J, Lemaire F, Brochard L. Prevention of endotracheal suctioning-induced alveolar derecruitment in acute lung injury. American Journal of Respiratory Critical Care Medicine. 2003;167:1215-1224. https://doi.org/10.1164/rccm.200203-195OC
  27. Cereda M, Gerardo OS. Closed system endotracheal suctioning maintains lung volume during volume- controlled mechanical ventilation. Intensive Care Medicine. 2001;27:648-654.  https://doi.org/10.1007/s001340100897
  28. Corley A, Sharpe N, Caruana LR, Spooner AJ, Fraser JF. Lung volume changes during cleaning of closed endotracheal suction catheters: a randomized crossover study using electrical impedance tomography. Respiratory Care. 2014;59(4):497-503.  https://doi.org/10.4187/respcare.02601
  29. Zilberberg MD, Shorr AF. Ventilator-Associated Pneumonia: The Clinical pulmonary infection score as a surrogate for diagnostics and outcome. Clinical Infectious Diseases: an Official Publication of the Infectious Diseases Society of America. 2010;51(1):131-135.  https://doi.org/10.1086/653062
  30. Shan J, Chen HL, Zhu JH. Diagnostic accuracy of clinical pulmonary infection score for ventilator-associated pneumonia: a meta-analysis. Respiratory Care. 2011;56(8):1087-1094. https://doi.org/10.4187/respcare.01097
  31. Gel’fand BR. Nozokomial’naya pnevmoniya u vzroslykh: Rossiyskie natsional’nye rekomendatsii. M.: OOO»MIA»; 2016. (In Russ.).
  32. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, Napolitano LM, O’Grady NP, Bartlett JG, Carratalà J, El Solh AA, Ewig S, Fey PD, File TM, Jr, Restrepo MI, Roberts JA, Waterer GW, Cruse P, Knight SL, Brozek JL. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clinical Infectious Diseases: an Official Publication of the Infectious Diseases Society of America. 2016;63(5):61-111.  https://doi.org/10.1093/cid/ciw353
  33. Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, Kollef M, Li Bassi G, Luna CM, Martin-Loeches I, Paiva JA, Read RC, Rigau D, Timsit JF, Welte T, Wunderink R. International ERS/ESICM /ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia. The European Respiratory Journal. 2017;50:1700582. https://doi.org/10.1183/13993003.00582-2017
  34. Lorente L, Lecuona M, Martín MM, García C, Mora ML, Sierra A. Ventilator-associated pneumonia using a closed versus an open tracheal suction system. Critical Care Medicine. 2005;33(1):115-119.  https://doi.org/10.1097/01.ccm.0000150267.40396.90
  35. Jongerden IP, Rovers MM, Grypdonck MH, Bonten MJ. Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: a meta-analysis. Critical Care Medicine. 2007;35(1):260-270.  https://doi.org/10.1097/01.ccm.0000251126.45980.e8
  36. Siempos II, Vardakas KZ, Falagas ME. Closed tracheal suction systems for prevention of ventilator-associated pneumonia. British Journal of Anaesthesia. 2008;100(3):299-306.  https://doi.org/10.1093/bja/aem403
  37. Cha KS, Park HR. Endotracheal colonization and ventilator-associated pneumonia in mechanically ventilated patients according to type of endotracheal suction system. Journal of Korean Academy of Nursing. 2011;41(2):175.  https://doi.org/10.4040/jkan.2011.41.2.175
  38. Ego A, Preiser JC, Vincent JL. Impact of diagnostic criteria on the incidence of ventilator-associated pneumoniae. Chest. 2015;147(2):347-355.  https://doi.org/10.1378/chest.14-0610
  39. Abdo-Cuza A, Díaz-Águila H, Valdés-Suarez O, Castellanos-Gutiérrez R, Suárez-López J, Machado-Martínez R. Lung ultrasound in ventilator associated pneumonia: light or more shadow at diagnosis. Medical Archives. 2019;11(1):1.  https://doi.org/10.36648/1989-5216.11.1.293
  40. Bourcier JE, Paquet J, Seinger M, Gallard E, Redonnet JP, Cheddadi F, Garnier D, Bourgeois JM, Geeraerts T. Performance comparison of lung ultrasound and chest x-ray for the diagnosis of pneumonia in the ED. American Journal of Emergency Medicine. 2014;32(2):115-118.  https://doi.org/10.1016/j.ajem.2013.10.003
  41. Alzahrani SA, Al-Salamah MA, Al-Madani WH, Elbarbary MA. Systematic review and meta-analysis for the use of ultrasound versus radiology in diagnosing of pneumonia. Critical Ultrasound Journal. 2017;9(1):6.  https://doi.org/10.1186/s13089-017-0059-y
  42. Bekaert M, Timsit JF, Vansteelandt S, Depuydt P, Vésin A, Garrouste-Orgeas M, Decruyenaere J, Clec’h C, Azoulay E, Benoit D; Outcomerea Study Group. Attributable mortality of ventilator-associated pneumonia: a reappraisal using causal analysis. American Journal of Respiratory Critical Care Medicine. 2011;184(10):1133-1139. https://doi.org/10.1164/rccm.201105-0867OC
  43. Nguile-Makao M, Zahar JR, Français A, Tabah A, Garrouste-Orgeas M, Allaouchiche B, Goldgran-Toledano D, Azoulay E, Adrie C, Jamali S, Clec’h C, Souweine B, Timsit JF. Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi- state models. Intensive Care Medicine. 2010;36(5):781-789.  https://doi.org/10.1007/s00134-010-1824-6
  44. Williamson DR, Albert M, Perreault MM, Delisle MS, Muscedere J, Rotstein C, Jiang X, Heyland DK. The relationship between Candida species cultured from the respiratory tract and systemic inflammation in critically ill patients with ventilator-associated pneumonia. Canadian Journal of Anaesthesia. 2011;58:275-284.  https://doi.org/10.1007/s12630-010-9439-5
  45. Timsit JF, Schwebel C, Styfalova L, Cornet M, Poirier P, Forrestier C, Ruckly S, Jacob MC, Souweine B. Impact of bronchial colonization with Candida spp. on the risk of bacterial ventilator-associated pneumonia in the ICU: the FUNGIBACT prospective cohort study. Intensive Care Medicine. 2019;45(6):834-843.  https://doi.org/10.1007/s00134-019-05622-0
  46. Huffnagle GB, Dickson RP, Lukacs NW. The respiratory tract microbiome and lung inflammation: a two-way street. Mucosal Immunology. 2017;10(2):299-306.  https://doi.org/10.1038/mi.2016.108
  47. Roux D, Van Oort PM, Ricard JD, Bos LDJ. Airway microbiome research: a modern perspective on surveillance cultures? Annals of Translational Medicine. 2017;5(22):1-7.  https://doi.org/10.21037/atm.2017.08.05
  48. Poroyko V, Meng F, Meliton A, Afonyushkin T, Ulanov A, Semenyuk E, Latif O, Tesic V, Birukova AA, Birukov KG. Alterations of lung microbiota in a mouse model of LPS-induced lung injury. American Journal of Physiology. Lung Cellular and Molecular Physiology. 2015;309(1):76-83.  https://doi.org/10.1152/ajplung.00061.2014
  49. Six S, Jaffal K, Ledoux G, Jaillette E, Wallet F, Nseir S. Hyperoxemia as a risk factor for ventilator-associated pneumonia. Critical Care. 2016;20(1):195.  https://doi.org/10.1186/s13054-016-1368-4
  50. Sinikin VA, Beloborodov VB. Prospective monitoring of airway colonization as way to ventilator-associated pneumonia prophylaxis. Epidemiologiya i infektsionnye bolezni. 2017;22(3):139-144. (In Russ.). https://doi.org/10.18821/1560-9529-2017-22-3-139-144
  51. Dickson RP, Huffnagle GB. The Lung Microbiome: new principles for respiratory bacteriology in health and disease. PLoS Pathogens. 2015;11(7);1-5.  https://doi.org/10.1371/journal.ppat.1004923
  52. Lau ACW, So HM, Tang SL, Yeung A, Lam SM, Yan WW. Prevention of ventilator-associated pneumonia. Hong Kong Medical Journal. 2015;21(1):61-68.  https://doi.org/10.12809/hkmj144367
  53. Siempos II, Ntaidou TK, Filippidis FT, Choi AMK. Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis. Lancet Respiratory Medicine. 2015;3:150-158.  https://doi.org/10.1016/S2213-2600(15)00007-7

Close metadata

Contact the author
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

Contact us
If you have any questions, complaints or suggestions, please use this feedback form.
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.
Submit Application

You can become an author of one of our magazines, send a request and we will consider it in during the day.

Name
Phone
E-mail
Message
Login
Registration
E-mail
Password
Forgot Password?

Log in to the site using your account in one of the services

Password recovery
E-mail
Login
Register


We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.