title: Investigation into the effect of closed-system suctioning on the frequency of pediatric ventilator-associated pneumonia in a developing country.
abstract: OBJECTIVE
  To investigate the effect of closed-system vs. open endotracheal suctioning on the frequency of ventilator-associated pneumonia and outcome in a pediatric intensive care unit in a developing country.
  
  
  METHODS
  Prospective observational and nonrandomized controlled clinical study.
  
  
  METHODS
  A 20-bed pediatric intensive care unit in a tertiary pediatric hospital.
  
  
  METHODS
  Infants and children mechanically ventilated for >24 hrs.
  
  
  METHODS
  : Pediatric intensive care unit suctioning systems were alternated monthly. An 8-month interim analysis was planned with a priori efficacy and futility study termination boundaries set at p < .006 and p > .52, respectively.
  
  
  RESULTS
  Demographic, clinical, and laboratory data were prospectively recorded. Ventilator-associated pneumonia was diagnosed using the Clinical Pulmonary Infection Score, and the results were confirmed retrospectively using Centers for Disease Control criteria. A total of 250 patients (median [interquartile range] age of 3.8 [1.2-15.0] months) in 263 pediatric intensive care unit admissions were included. Fifty-nine admissions developed ventilator-associated pneumonia, with a calculated rate of 45.1 infections per 1000 ventilated days. There was no difference in characteristics or outcome between patients on closed-system suctioning (n = 83) and those on open endotracheal suctioning (n = 180). The frequencies of ventilator-associated pneumonia for patients on closed-system suctioning and open endotracheal suctioning were 20.5% and 23.3%, respectively (p = .6), reaching the a priori set limit of futility. Patients who developed ventilator-associated pneumonia spent a median (interquartile range) of 22 (13-37) and 11 (8-16) days in the hospital and pediatric intensive care unit, respectively, compared to 14.5 (10-24) and 6 (4-8) days for those without ventilator-associated pneumonia (p < .001). A 22% proportion of patients who developed ventilator-associated pneumonia died compared to 11.3% of those without ventilator-associated pneumonia (p = .03). Risk factors for ventilator-associated pneumonia identified on multiple logistic regression were duration of mechanical ventilation, transport out of the pediatric intensive care unit, and blood transfusion.
  
  
  CONCLUSIONS
  Closed-system suctioning did not affect the frequency of ventilator-associated pneumonia or patient outcome in this setting.
authors.affiliation: Division of Paediatric Critical Care and Children's Heart Disease, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. brenda.morrow@uct.ac.za
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Morrow
authors.forename: Rukaiya
authors.initials: R
authors.lastname: Mowzer
authors.forename: Richard
authors.initials: R
authors.lastname: Pitcher
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Argent
mesh_terms: D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000401:mortality / Q000517:prevention & control* / Q000628:therapy*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D017751:Safety Management; D012720:Severity of Illness Index; D013396:Suction / Q000379:methods* / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome