Open versus Closed Suctioning Among Mechanically Ventilated Pediatric Patients: A Randomised Control Trial

Area of Science:

• Critical Care Medicine
• Pediatric Pulmonology
• Infectious Disease Control

Background:

• Ventilator-associated pneumonia (VAP) is a significant concern in mechanically ventilated pediatric patients.
• Tracheal suctioning is essential for airway management but can introduce pathogens.
• Both closed tracheal suction systems (CTSS) and open tracheal suction systems (OTSS) are used, with varying reported efficacies.

Purpose of the Study:

• To compare the efficacy of CTSS versus OTSS in reducing VAP incidence in pediatric patients.
• To evaluate the impact of CTSS and OTSS on cardio-respiratory parameters, mortality, and intubation duration.
• To assess the incidence of infection-related ventilator-associated conditions (IVAC) between the two suction systems.

Main Methods:

• A single-center, parallel-group, open-label, randomized controlled study with 1:1 allocation.
• 116 pediatric patients requiring mechanical ventilation were randomized to either CTSS or OTSS.
• Demographic, clinical, laboratory parameters, and treatment outcomes were recorded.

Main Results:

• The overall incidence of VAP was similar between CTSS and OTSS groups (7.75%).
• A significantly higher number of IVAC were observed in the CTSS group compared to the OTSS group (RR 3.5).
• Oxygen saturation (SpO2) was better maintained post-suction in the CTSS group (p=0.001), while mortality and intubation days were similar.

Conclusions:

• The incidence of VAP is comparable between CTSS and OTSS in pediatric patients.
• CTSS may be associated with a higher risk of IVAC despite similar VAP rates.
• Further research is needed to optimize suctioning strategies for pediatric mechanical ventilation.