title: An open-labelled randomized controlled trial comparing costs and clinical outcomes of open endotracheal suctioning with closed endotracheal suctioning in mechanically ventilated medical intensive care patients.
abstract: OBJECTIVE
  Closed endotracheal suctioning (CES) may impact ventilator-associated pneumonia (VAP) risk by reducing environmental contamination. In developing countries where resource limitations constrain the provision of optimal bed space for critically ill patients, CES assumes greater importance.
  
  
  METHODS
  In this prospective, open-labeled, randomized controlled trial spanning 10 months, we compared CES with open endotracheal suctioning (OES) in mechanically ventilated patients admitted to the medical intensive care unit (ICU) of a university-affiliated teaching hospital. Patients were followed up from ICU admission to death or discharge from hospital. Primary outcome was incidence of VAP. Secondary outcomes included mortality, cost, and length of stay.
  
  
  RESULTS
  Two hundred patients were recruited, 100 in each arm. The incidence of VAP was 23.5%. Closed endotracheal suctioning was associated with a trend to a reduced incidence of VAP (odds ratio, 1.86; 95% confidence interval, 0.91-3.83; P = .067). A significant benefit was, however, observed with CES for late-onset VAP (P = .03). Mortality and duration of ICU and hospital stay were similar in the 2 groups. The cost of suction catheters and gloves was significantly higher with CES (Rs 272 [US $5.81] vs Rs 138 [US $2.94], P < .0001). Nine patients need to be treated with CES to prevent 1 VAP (95% confidence interval, -0.7 to 22).
  
  
  CONCLUSIONS
  In the ICU setting in a developing country, CES may be advantageous in reducing the incidence of VAP, particularly late-onset VAP. These results mandate further studies in this setting before specific guidelines regarding the routine use of CES are proposed.
authors.affiliation: Department of Medicine II, Christian Medical College & Hospital, Vellore, 632004, Tamil Nadu, India. Electronic address: deepudavid@gmail.com.
authors.forename: Deepu
authors.initials: D
authors.lastname: David
authors.affiliation: Department of Biostatistics, Christian Medical College and Hospital, Vellore, India.
authors.forename: Prasanna
authors.initials: P
authors.lastname: Samuel
authors.affiliation: Department of Medicine II, Christian Medical College & Hospital, Vellore, 632004, Tamil Nadu, India.
authors.forename: Thambu
authors.initials: T
authors.lastname: David
authors.affiliation: Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India.
authors.forename: Shyamkumar Nidugala
authors.initials: SN
authors.lastname: Keshava
authors.affiliation: Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India.
authors.forename: Aparna
authors.initials: A
authors.lastname: Irodi
authors.affiliation: Medical Intensive Care Unit, Christian Medical College and Hospital, Vellore, India.
authors.forename: John Victor
authors.initials: JV
authors.lastname: Peter
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D003422:Critical Care / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D012307:Risk Factors; D013396:Suction / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome