title: Closed suctioning system: critical analysis for its use.
abstract: OBJECTIVE
  To determine the efficacy and effectiveness of the closed suctioning system.
  
  
  METHODS
  Literature review articles were accessed from the following databases: PubMed, EMBASE, CINAHL, and Cochrane Library. The literature review criteria included: all publication styles except meta-analysis, participants that were > or =18 years, written in English, and published between 1973 and 2008.
  
  
  RESULTS
  This literature review revealed that the efficacy and effectiveness of the closed suctioning system remains to be demonstrated. The device manufacturers' studies focused on cost reduction, cross-contamination, and preservation of the oxygen saturation of patients during endotracheal suctioning; however, the clinical studies focused on the use of closed suctioning systems to prevent ventilator-associated pneumonia. The reviewed studies had small sample sizes with heterogeneous demographics and non-randomized controls. Recent studies suggest that closed suctioning systems are no better than open suctioning systems in terms of mortality, morbidity, or the cost-benefit ratio. A few studies did indicate that the closed suctioning system might reduce the loss of lung volume and oxygen desaturation.
  
  
  CONCLUSIONS
  The studies reviewed in this article suggest that the evidence on the efficacy and effectiveness of closed suctioning systems is inconclusive. Only limited populations will benefit clinically from the use of this device. There is a need for further studies with randomized controlled trials to explore the use of closed suction systems and to update current clinical practise guidelines.
authors.affiliation: William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA. haradan@bc.edu
authors.forename: Nahoko
authors.initials: N
authors.lastname: Harada
mesh_terms: D003422:Critical Care; D006801:Humans; D012121:Respiration, Artificial; D013396:Suction / Q000295:instrumentation