Acute Effects of Open and Closed Suction Systems in Mechanically Ventilated Patients
Condition: Mechanical Ventilation
Study type: Interventional

Summary: 
      Seventy-one patients in intensive care were randomized for initial treatment with open
      suction systems or closed suction systems in a cross-over design. Pulmonary and
      cardiovascular physiology was assessed immediately before and after three 10-second
      aspirations per suction. Were analyzed the effect of each suction system on physiologic
      parameters while adjusting for their respective values prior to suction.
    

Detailed description: 
      Study Participants. The sample consisted of 71 subjects, both genders, hospitalized in
      intensive care units. This study protocol was approved by the Research Ethics Committee of
      Heliopolis Hospital - Sao Paulo - Brazil.

      Patients were randomized in the following way: patients hospitalized in the odd beds of ICU
      were aspirated initially by open suction system (OSS) and later by the closed suction system
      (CSS); patients hospitalized in the even beds were aspirated by CSS, initially, and
      subsequently by the OSS.

      Cardiopulmonary measures: Eligible patients were evaluated for the presence or absence of
      neural stimulation to spontaneous ventilation (drive breathing). If the patients showed
      spontaneous respiratory movements, they were sedated to the level four of Ramsay scale. After
      this initial evaluation, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean
      blood pressure (MBP), heart rate (HR), respiratory rate (RR), oxygen saturation (SAT), tidal
      volume (Vt), peak pressure (Ppeak), plateau pressure (Pplat), positive end expiratory
      pressure (PEEP), and inspiratory flow (V) were measured. The HR and SAT data were collected
      by visualization of DX 2010 multiparameter monitor from Dixtal. SBP, DBP and MBP were
      obtained by a single measurement provided by the same monitor. Data of peak pressure, plateau
      pressure, positive end expiratory pressure, inspiratory flow and tidal volume were used to
      calculate compliance (C) and airway resistance (R). Data were collected before and after
      tracheal aspiration.

      Pulmonary Suction: After the initial data were obtained, patients who were under
      volume-controlled ventilation mode (VCV) were submitted to the first aspiration procedure
      according to randomization described above. Patients who were under pressure-controlled
      ventilation mode (PCV) were changed to VCV mode, respecting the individual mean tidal volume,
      which means that the tidal volume of the patient under PCV would be used to ventilate in VCV.
      All patients were ventilated with a Savina (Drager) mechanical ventilator. Aspiration
      procedures and data collection were done by a health care professional unaware of the study
      regimes or objectives. After the measurement of the initial parameters, patients underwent
      the procedure of aspiration in an open or closed system according to the randomization
      described above. All patients were aspirated by a system that had not been used previously.
      The procedure was timed and required 10 seconds to insert and remove the aspiration catheter,
      with each aspiration performed three times. The outside diameter of the aspiration catheter
      had half the inner diameter of the endotracheal tube, and the negative pressure was adjusted
      between 70 and 100 mmHg. At the end of the aspiration procedure, physiological assessments
      were repeated. Patients were returned to nursing care and underwent the second procedure
      after six hours from initial aspiration.
    

Intervention name(s): Closed suction system; Open suction system
Intervention type(s): Procedure; Procedure
Intervention description(s): In mechanically ventilated patients, intratracheal secretions were aspirated with closed suction systems to compare the pulmonary and cardiovascular parameters (Peak Pressure, Resistance, and Pressure Plateau, Heart Rate and Mean, Diastolic, and Systolic Pressures) with open suction system.; In mechanically ventilated patients, intratracheal secretions were aspirated with open suction systems to compare the pulmonary and cardiovascular parameters (Peak Pressure, Resistance, and Pressure Plateau, Heart Rate and Mean, Diastolic, and Systolic Pressures) with closed suction system.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Treatment