EFFECTS OF CLOSED SYSTEM SUCTION TECHNIQUE ON VAP (VENTILATOR ASSOCIAED PNEUMONIA) AND OXYGEN SATURATION IN PATIENTS WITH MECHANICAL VENTILATOR.

Abstract

          Objective: Ventilator-associated pneumonia (VAP) continues to be an important cause of morbidity and mortality in critically ill patients. It is a serious complication of patients in intensive care units (ICU) who require mechanical ventilation (MV). This aimed to study the effects of Closed System Suction (CSS) on Ventilator Associated Pneumonia (VAP) and Oxygen (O₂) saturation in patients with MV in ICU at Bamaranadura Infectious Disease Institute

          Materials and Methods: A Quasi experimental research prospective study during 14 months. The inclusion criteria were: surgical and medical patients older than 13 years, undergoing MV for more than 48 hours. in ICU at Bamaranadura Infectious Disease Institute during December 2005-Febuary 2007. Patients were randomized into two groups: one group was suctioned with CSS, and another group with OSS. VAP was defined according to the following criteria: CDC guideline for VAP surveillance. The O₂ saturation was evaluated before suctioning, then at the first, fifth and tenth minute after suctioning. The instrument in this study consisted of two parts. The first part was the guideline of endotracheal tube suctioning both CSS and OSS, and the guide-line for VAP surveillance. The second part was the record of patient's duration, the incidence of VAP, the O₂ saturation. Data were analyzed by using frequency, mean, Chi-Square Test, and Mann - Whitney U Test.

          Results: Among the 28 patients having open- endotracheal suction, 11 developed nosocomial pneumonia while of the 28 patients undergoing closed- endotracheal suction, nine developed infection (P = 0.51). and O₂ saturation after suctioning 1, 5 and 10 minutes no significant. However, loss of O₂ saturation in CSS tended to lower than in OSS.

          Conclusions: Although the CSS did not decrease the incidence of VAP when compared with the OSS. CSS should be the option to use in patients with severe or dangerous respiratory tract infection such as SARS, Avian flu, Advance Multiple Drug Resistance Pulmonary Tuberculosis, in order to prevent the risk of respiratory transmission to the health care personnel and also to prevent the spread of infection to the environment. The choice of suctioning system should therefore be based on handling, cost, and individual patient's disease until more data are available. Furthermore, this study should be repeated with additional samples to evaluate the cost benefit of CSS.