title: Impact of the suctioning system (open vs. closed) on the incidence of ventilation-associated pneumonia: Meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Ventilation-associated pneumonia (VAP) is a serious complication of patients in intensive care units (ICU) who require mechanical ventilation. The choice of suctioning system (open vs. closed) remains unresolved in evidence-based guidelines. This meta-analysis was carried out to analyze the effect of the type of suctioning system on the incidence of VAP.
  
  
  METHODS
  A search of the literature was used to identify randomized controlled trials addressing this question. A meta-analysis was then performed to calculate the relative risk of ventilation-associated pneumonia acquisition with the two suctioning systems.
  
  
  RESULTS
  Nine trials were included, with 648 patients in the open suctioning group and 644 in the closed suctioning group. VAP occurred in 128 (20%) of the open suctioning group and in 120 (19%) in the closed suctioning group (relative risk 0.95).
  
  
  CONCLUSIONS
  At a given pneumonia prevalence of 20% in ICU patients there was no significant advantage for the use of either suctioning system in this meta-analysis. The choice of suctioning system should therefore be based on handling, cost, and individual patient's disease until more data are available.
authors.affiliation: Institute for Medical Microbiology and Hospital Epidemiology, Medical School of Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. Vonberg.Ralf@MH-Hannover.de
authors.forename: Ralf-Peter
authors.initials: RP
authors.lastname: Vonberg
authors.forename: Tim
authors.initials: T
authors.lastname: Eckmanns
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
mesh_terms: D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013396:Suction / Q000379:methods*; D012122:Ventilators, Mechanical / Q000009:adverse effects*