title: Ventilator-associated pneumonia using a closed versus an open tracheal suction system.
abstract: OBJECTIVE
  The aim of this study was to analyze the prevalence of ventilator-associated pneumonia (VAP) using a closed-tracheal suction system vs. an open system.
  
  
  METHODS
  Prospective and randomized study, from October 1, 2002, to December 31, 2003.
  
  
  METHODS
  A 24-bed medical-surgical intensive care unit in a 650-bed tertiary hospital.
  
  
  METHODS
  Patients requiring mechanical ventilation for >24 hrs.
  
  
  METHODS
  Patients were randomized into two groups; one group was suctioned with the closed-tracheal suctioning system and another group with the open system.
  
  
  METHODS
  Throat swabs were taken at admission and twice a week until discharge to classify pneumonia in endogenous and exogenous.
  
  
  RESULTS
  A total of 443 patients (210 with closed-tracheal suction system and 233 with the open system) were included. There were no significant differences between groups of patients in age, sex, diagnosis groups, mortality, number of aspirations per day, and Acute Physiology and Chronic Health Evaluation II score. No significant differences were found in either the percentage of patients who developed VAP (20.47% vs. 18.02%) or in the number of VAP cases per 1000 mechanical ventilation-days (17.59 vs. 15.84). There were also no differences in the VAP incidence by mechanical ventilation duration. At the same time, we did not find any differences in the incidence of exogenous VAP. Likewise, there were also no differences in the microorganisms responsible for pneumonia. Patient cost per day for the closed suction was more expensive than the open suction system (11.11 US dollars +/- 2.25 US dollars vs. 2.50 US dollars +/- 1.12 US dollars, p < .001).
  
  
  CONCLUSIONS
  We conclude that in our study, the closed-tracheal suction system did not reduce VAP incidence, even for exogenous pneumonia.
authors.affiliation: Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lorente
authors.forename: María
authors.initials: M
authors.lastname: Lecuona
authors.forename: María M
authors.initials: MM
authors.lastname: Martín
authors.forename: Carolina
authors.initials: C
authors.lastname: García
authors.forename: María L
authors.initials: ML
authors.lastname: Mora
authors.forename: Antonio
authors.initials: A
authors.lastname: Sierra
mesh_terms: D000328:Adult; D000368:Aged; D001431:Bacteriological Techniques; D003362:Cost-Benefit Analysis; D003422:Critical Care; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004867:Equipment Design; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D011446:Prospective Studies; D013030:Spain; D013396:Suction / Q000191:economics / Q000295:instrumentation*; D014132:Trachea / Q000382:microbiology; D012122:Ventilators, Mechanical / Q000191:economics