title: Tracheal suction by closed system without daily change versus open system.
abstract: BACKGROUND
  Tracheal suctioning costs are higher with a closed tracheal suction system (CTSS) than with an open system (OTSS), due to the need for complete daily change as recommended by the manufacturer. However, is it necessary to change the closed system daily?
  
  
  OBJECTIVE
  To evaluate the tracheal suctioning costs and incidence of ventilator-associated pneumonia (VAP) using closed system without daily change vs OTSS.
  
  
  METHODS
  Prospective and randomised study.
  
  
  METHODS
  An Intensive Care Unit in a university hospital.
  
  
  METHODS
  Patients requiring mechanical ventilation.
  
  
  METHODS
  Patients were randomly assigned to CTSS without daily change or OTSS. We used a CTSS that allowed partial or complete change.
  
  
  RESULTS
  There were no significant differences between both groups of patients (236 with CTSS and 221 with OTSS) in gender, age, diagnosis, APACHE-II score, mortality, number of aspirations per day, percentage of patients who developed VAP (13.9 vs 14.1%) or the number of ventilator-associated pneumonia per 1000 days of mechanical ventilation (14.1 vs 14.6). There were not significant differences in tracheal suctioning costs per patient/day between CTSS vs OTSS (2.3+/-3.7 vs 2.4+/-0.5 Euros; p=0.96); however, when length of mechanical ventilation was lower than 4 days, the cost was higher with CTSS than with OTSS (7.2+/-4.7 vs 1.9+/-0.6 Euros; p<0.001); and when length of mechanical ventilation was higher than 4days, the cost was lower with CTSS than with OTSS (1.6+/-2.8 vs 2.5+/-0.5 Euros; p<0.001).
  
  
  CONCLUSIONS
  CTSS without daily change is the optimal option for patients needing tracheal suction longer than 4 days.
authors.affiliation: Department of Critical Care, Hospital Universitario de Canarias, Ofra s/n, La Cuesta, La Laguna, 38320, Santa Cruz de Tenerife, Spain. lorentemartin@msn.com
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lorente
authors.forename: María
authors.initials: M
authors.lastname: Lecuona
authors.forename: Alejandro
authors.initials: A
authors.lastname: Jiménez
authors.forename: María L
authors.initials: ML
authors.lastname: Mora
authors.forename: Antonio
authors.initials: A
authors.lastname: Sierra
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D003422:Critical Care; D004867:Equipment Design; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D013396:Suction / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D014132:Trachea / Q000382:microbiology; D012122:Ventilators, Mechanical / Q000191:economics