Comparison Of Effects With Open Versus Closed Suction System In Endotracheal Preterm Neonates

Objectives To compare SpO2 and HR changes between the open suction system and closed suction system in preterm babies before and after suctioning.To compare the severity and incidences of desaturation and bradycardia between the two groups and the time for SpO2 and HR recover to the baseline.To determine whether ventilated preterm infants treated with closed versus open tracheal suction in a neonatal intensive care unit differ as to airway bacterial colonization,incidence of obstruction of the endotracheal tube(ETT),all kinds of complications.Methods In NICU of Children's hospital of Fudan University,fourty-five intubated and ventilated premature babies in each group randomly separately underwent closed suction technique and open suction technique after intubated. Four of eight study nurses were trained to perform the two techniques and the other four nurses were trained to record all the datas.We produced the suction process based on evidence.And closed multi-use catheters were changed every 7days;open catheters were changed after every use.Two-pass endotracheal suctioning was performed as needed.Parental consent was obtained and Research Ethics Committee approved the study. 1)The next day of intubation,the data of the first suction in day shift were recorded. Changes in oxygen saturation measured with pulse oximetry and heart rate changes measured with electrocardiogram were recorded using Philips monitors.The time for SpO2 and HR recover to the baseline were recorded.Side-port connectors were not used;thus open suction required disconnection from ventilators.2)The incidence of obstruction of ETT were recorded from the first day of intubation to the day extubation.3) Tracheal aspirate cultures were obtained on admission and weekly thereafter until extubation.Nosocomial BSI(occurring after 48 hours of life)was documented by positive blood cultures.All the complications like pneumothorax,intracranial hemorrhage,retinopathy of prematurity were documented. Blood gas result before and after intubation were documented and we also documented the NICU days and intubation duration.Results The study population comprised of 45 patients in the closed group and 45 in the open group who were ventilated longer than 24h. Groups were not statistically different in terms of demographic and clinical characteristics.Closed tracheal sution system reported a significantly smaller degree of oxygen saturation fall(P<0.05) and significantly fewer incidences of desaturation.There were also significantly smaller degree of heart rate reduction and episodes of bradycardia were significantly differenct between the two methods.Oxygen saturation and heart rate were significantly more stable during the use of closed suction system compared to open suction system in preterm population.Aspirate mass were dry in closed suction group more than open suction group.A total of 11 patients in open group and 3 patients in closed group became airway colonized with Gram-negative bacilli difference was statistically significant. Compli- cations between two groups found no statistically signification. A total of 17 of 34 NICU nurses considered closed suction to be easier to use,less time-consuming,and better tolerated by the patient.Conclusions Closed suction obviates the physiological disadvantage of ventilator disconnection without increasing the rate of bacterial airway colonization,duration of mechanical ventilation,length of hospitaliza- tion,complications.Oxygen saturation and heart rate were significantly more stable during the use of closed suction system compared to open suction system in preterm population.