Meta-analysis of the clinical effect of different sputum suction methods on mechanically ventilated patients
WANG Jing1 HU Tao2 JIN Feng2 HUANG Yumin2 QIU Jin2 OU YANG Xiaoping2#br#
1.Department of Infectious Diseases, Affiliated Hospital of Yangzhou University, Jiangsu Province, Yangzhou 225000, China;
2.Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Yangzhou University, Jiangsu Province, Yangzhou 225000, China
Abstract：Objective To evaluate the clinical effect of different sputum suction methods on the prevention of ventilator-associated pneumonia (VAP). Methods The Cochrane Library, Wanfang Data, PubMed, VIP, and Chinese journal full-text databases were searched to collect randomized controlled trials (RCTs) comparisons of the effects of open sputum suction (OTSS) and closed sputum suction (CTSS) on VAP in mechanically ventilated patients trial, the search period was from the establishment of the database to May 2021. Two researchers conducted quality evaluation and data extraction of the literature, and used RevMan 5.3 statistical processing to conduct a meta-analysis of the included RCTs. Results A total of 15 RCTs with a total of 3 029 patients were included. Meta-analysis results showed that CTSS could reduce the incidence of VAP (OR = 0.74, 95%CI[0.59 to 0.93], P = 0.01) and the incidence of arrhythmia (OR = 0.23, 95%CI [0.07 to 0.74], P = 0.01), there was no statistically significant difference between the two in terms of shortened ICU stay (MD = -0.13, 95%CI[-2.23 to 1.96], P = 0.9), decreased respiratory tract microbial colonization rate (OR = 1.14, 95%CI[0.84 to 1.23], P = 0.89). Conclusion CTSS has advantages over OTSS in preventing the occurrence of VAP and reducing arrhythmia in mechanically ventilated patients, but not in shortening ICU hospital stay, reducing mortality, shortening mechanical ventilation time and reducing respiratory tract microbial colonization rate.
王晶1 胡涛2 金凤2 黄玉民2 邱瑾2 欧阳晓平2. 不同吸痰方式对机械通气患者临床效果的meta分析[J]. 中国医药导报, 2022, 19(28): 96-101.
WANG Jing1 HU Tao2 JIN Feng2 HUANG Yumin2 QIU Jin2 OU YANG Xiaoping2. Meta-analysis of the clinical effect of different sputum suction methods on mechanically ventilated patients. 中国医药导报, 2022, 19(28): 96-101.
[1] 郑伟，王苹力，毛宁.早期纤维支气管镜灌洗吸痰在微创食管癌术后肺部并发症中的临床研究[J].中华老年医学杂志，2020，39（3）：269-272.
[2] Alvear-Vega S，Canteros-Gatica J. Performance evaluation of APACHE Ⅱ and SAPS Ⅲ in an intensive care unit. [J]. Rev Salud Publica （Bogota），2018，20（3）：373-377.
[3] 崔建伟，张文敏，赵炳朕，等.呼吸机相关性肺炎与非呼吸机相关性肺炎的病原菌在ICU患者中分布的对比分析[J].现代诊断与治疗，2016，27（16）：2941-2943.
[4] Paul-Allen J，Ostrow CL. Survey of nursing practices with closed-system suctioning [J]. Am J Crit Care，2000，9（1）：9-17
[5] Magill SS，O’Leary E，Janelle SJ，et al. Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals [J]. N Engl J Med，2018，379（18）：1732-1744.
[6] American Association for Respiratory Care. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010 [J]. Respiratory Care，2010，55（6）：758-764.
[7] Adams DH，Hughes M，Elliott TS. Microbial colonization of closed-system suction catheters used in liver transplant patients [J]. Intensiv Crit Care Nurs，1997，13（2）：72-76.
[8] Alipour N，Manouchehrian N，Sanatkar M，et al. Evaluation of the effect of open and closed tracheal suction on the incidence of ventilator associated pneumonia in patients admitted in the intensive care unit [J]. Archives of Anesthesiology and Critical Care，2016，2（2）：193-196.
[9] Ardehali SH，Fatemi A，Rezaei SF，et al. The Effects of Open and Closed Suction Methods on Occurrence of Ventilator Associated Pneumonia；a Comparative Study [J]. Arch Acad Emerg Med，2020，8（1）：e8.
[10] Combes P，Fauvage B，Oleyer C. Nosocomial pneumonia in mechanically ventilated patients，a prospective randomised evaluation of the Stericath closed suctioning system [J]. Intensive Care Med，2000，26（7）：878-882.
[11] David D，Samuel P，David T，et al. 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 [J]. J Crit Care，2010，26（5）：482-488.
[12] Elmansoury A，Said H. Closed suction system versus open suction [J]. Egyptian Journal of Chest Diseases and Tuberculosis，2017，66（3）：509-515.
[13] Hamishekar H，Shadvar K，Taghizadeh M，et al. Ventilator-associated pneumonia in patients admitted to intensive care units， using open or closed endotracheal suctioning [J]. Anesth Pain Med，2014，4（5）：e21649.
[14] Johnson KL，Kearney PA，Johnson SB，et al. Closed versus open endotracheal suctioning：costs and physiologic consequences [J]. Critical care medicine，1994，22（4）：658-666.
[15] Jongerden IP，Buiting AG，Leverstein-van Hall MA，et al. Effect of open and closed endotracheal suctioning on cross-transmission with Gram-negative bacteria：a prospective crossover study [J]. Critl Care Med，2011，39（6）：1313-1321.
[16] Lee CK，Ng KS，Tan SG，et al. Effect of different endotracheal suctioning systems on cardiorespiratory parameters of ventilated patients [J]. Ann Acad Med Singap，2001， 30（3）：239-244.
[17] Lorente L，Lecuona M，Martín MM，et al. Ventilator-associated pneumonia using a closed versus an open tracheal suction system [J]. Crit Care Med，2005，33（1）：115-119.
[18] Lorente L，Lecuona M，Jiménez A，et al. Tracheal suction by closed system without daily change versus open system [J]. Intensive Care Med，2006，32（4）：538-544.
[19] Topeli A，Harmanci A，Cetinkaya Y，et al. Comparison of the effect of closed versus open endotracheal suction systems on the development of ventilator-associated pneumonia [J]. J Hosp Infect，2004，58（1）：14-19.
[20] Zeitoun SS，de Barros AL，Diccini S. A prospective， randomized study of ventilator-associated pneumonia in patients using a closed vs. open suction system [J]. J Clin Nurs，2003，12（4）：484-489.
[21] 迟红丽，林淑梅，翟旭杰.人工鼻联合密闭式吸痰管预防呼吸机相关性肺炎的疗效[J].中国老年学杂志，2013， 33（18）：4629-4631.
[22] 田苗，张豪，左红霞，等.国内外不同吸痰方式对预防呼吸机相关性肺炎的Meta分析[J].湖北医药学院学报，2018，37（6）：504-510.
[23] ?魡kerman E，Larsson C，Ersson A. Clinical experience and incidence of ventilator-associated pneumonia using closed versus open suction-system [J]. Nurs Crit Care，2014，19（1）：34-41.
[24] Afshari A，Safari M，Oshvandi K，et al. The effect of the open and closed system suctions on cardiopulmonary parameters：time and costs in patients under mechanical ventilation [J]. Nursi Midwifery Stud，2014，3（2）：e14097.
京公网安备 11010502046598号