CLOSED VERSUS OPEN ENDOTRACHEAL SUCTIONING - COSTS AND PHYSIOLOGICAL CONSEQUENCES

Objective: To examine the physiologic consequences and costs associated with two methods of endotracheal suctioning: closed vs. open. Design: A prospective, randomized, controlled study. Setting: An eight-bed trauma intensive care unit (ICU) in a 460-bed level I trauma center. Patients: The study included 35 trauma/general surgery patients (16 in the open suction group, 19 in the closed suction group) who were treated with a total of 276 suctioning procedures (127 open, 149 closed). Measurements and Main Results: Physiologic data collected after hyperoxygenation, immediately after suctioning, and 30 sees after suctioning, were compared with baseline values. Open endotracheal suctioning resulted in significant increases in mean arterial pressure throughout the suctioning procedure. Both methods resulted in increased mean heart rates. However, 30 secs after the procedure, the open-suction method was associated with a significantly higher mean heart rate than was the closed method. Closed suctioning was associated with significantly fewer dysrhythmias. Arterial oxygen saturation and systemic venous oxygen saturation decreased with open suctioning. In contrast, arterial oxygen saturation and systemic venous oxygen saturation increased with the closed suction method. There was no difference between the two methods in the occurrence of nosocomial pneumonia. Open endotracheal suctioning cost $1.88 more per patient per day and required more nursing time. Conclusions: The closed suction method resulted in significantly fewer physiologic disturbances. Closed suctioning appears to be an effective and cost-efficient method of endotracheal suctioning that is associated with fewer suction-induced complications.