Invasieve beademing Module 5 Evidence-tabellen

Sanaie 2022

SR and meta-analysis of RCTs

Literature search up to June 2020

A: Alipour, 2016

B: Ardehali, 2020

C: Hamishekar, 2014

D: Combes, 2000

E: Topeli, 2004

F: Rabitsch, 2004

G: David, 2011

H: Lorente, 2005

I: Lorente, 2006

J: Zeitoun, 2003

Study design: All RCT

Source of funding and conflicts of interest:

Not reported by Sanaie, 2022

Inclusion criteria SR: randomized controlled trials (RCTs) with human adults that were published after 2000 and in English language comparing open endotracheal suctioning to closed endotracheal suctionoing with VAP as outcome measure.

Exclusion criteria SR:

(1) Review articles, case reports,

and conference abstracts; (2) The animal studies; (3) Original

articles not containing data on onset of VAP in CTSS and/or OTSS;

(4) Articles that were inaccessible after two times of mailing for

paper request from the corresponding author; (5) Articles

with unclear data description; (6) Duplicate reports; (7) Not

randomized articles; (8) Articles before year 2000.

10 studies included

Groups comparable at baseline?

Yes

Describe intervention:

All: Open endotracheal suctioning system

Describe control:

All: Closed endotracheal suctioning system

End-point of follow-up:

All: For duration of mechanical ventilation

For how many participants were no complete outcome data available?

(intervention/control)

All: NA

Outcome measure-1

Ventilator-associated pneumonia

Pooled effect (random effects model):

1.39 (95% CI 1.03 to 1.86) favoring closed endotracheal suctioning.

Risk of bias (high, some concerns or low):

Risk of bias assessment of included studies based on the Cochrane RoB2 tool. Al studies had bias regarding not being blinded both participants and outcomes.

The authors conclude that using CTSS can significantly decrease VAP development compared to OTSS. This conclusion does not yet mean the routine use of CTSS as a standard VAP prevention measure for all patients since individual patient’s disease and cost are other factors that should be in mind when determining the choice of the suctioning system.

Vijaysabari, 2024

Type of study: RCT

Setting and country: Hospital, India

Funding and conflicts of interest: no financial support and no conflicts of interest

Inclusion criteria:

patients aged > 18 years who required mechanical ventilation for > 48 consecutive hours were enrolled in this study.

Exclusion criteria:

Infants and neonates, patients who were unwilling to participate, and patients with pneumonia were excluded from the study.

N total at baseline:

Intervention: 42

Control:42

Important prognostic factors²:

Sex:

Intervention: 59.5% M

Control: 40.5% M

Groups comparable at baseline?

Yes

Describe intervention (treatment/procedure/test):

Open endotracheal suctioning

Describe control (treatment/procedure/test):

Closed endotracheal suctioning

Length of follow-up:

NA

Loss-to-follow-up:

NA

Incomplete outcome data:

NA

*patients had follow-up for duration of mechanical ventilation

Outcome measures and effect size (include 95%CI and p-value if available):

Developing VAP:

Open: 7/42 patients

Closed5/42 Patents

RR: 1.8 (95% CI 0.66 to 4.92) in favour of in favour of the closed endotracheal suction group.

The authors conclude that

There was no advantage of CTSS over OTSS

Dahl, 2024

Type of study: RCT

Setting and country: Hospital, India

Funding and conflicts of interest: no financial support and no conflicts of interest

Inclusion criteria:

Pediatric patients requiring mechanical ventilation

Exclusion criteria:

Not fulfilling inclusion criteria.

N total at baseline:

Intervention: 58

Control:58

Important prognostic factors²:

Sex:

Intervention: 62.1 M

Control: 50 M

Groups comparable at baseline?

Yes

Describe intervention (treatment/procedure/test):

Open endotracheal suctioning

Describe control (treatment/procedure/test):

Closed endotracheal suctioning

Length of follow-up:

NA

Loss-to-follow-up:

NA

Incomplete outcome data:

NA

*patients had follow-up for duration of mechanical ventilation

Outcome measures and effect size (include 95%CI and p-value if available):

Developing VAP:

Open: 3/58 patients

Closed 6/58 Patents

RR: 0.5 (95% CI 0.13 to 1.90) in favour of in favour of the open endotracheal suction group.

Duration of ventilation:

Open: 3.5 days (95%CI 2.75 to 6.35)

Closed: 5 days (95%CI 3 tot 8.35) in the closed

mean difference: -1.50 days (95% CI -3.5833 to 0.58) in favour of the open endotracheal suction group.

The authors conclude that Incidence of VAP was similar between open and closed suction groups

Gahan, 2024

Type of study: RCT

Setting and country: Hospital, India

Funding and conflicts of interest: no financial support and no conflicts of interest

Inclusion criteria:

Neonates born at >= 28 weeks and 800 g and

who were intubated within 72 h of birth were included in

the study

Exclusion criteria:

Neonates with major congenital malformations,

chromosomopathies, surgical needs, pulmonary hemorrhage,

pneumothorax before enrolment, and those who were intubated

and ventilated outside NICU for more than 6 h were

excluded from the study

N total at baseline:

Intervention: 41

Control: 39

Important prognostic factors²:

Groups comparable at baseline?

Yes

Describe intervention (treatment/procedure/test):

Open endotracheal suctioning

Describe control (treatment/procedure/test):

Closed endotracheal suctioning

Length of follow-up:

NA

Loss-to-follow-up:

NA

Incomplete outcome data:

NA

*patients had follow-up for duration of mechanical ventilation

Outcome measures and effect size (include 95%CI and p-value if available):

Developing VAP:

Open: 1/39 patients

Closed 3/41 Patents

RR: 0.035 (95% CI 0.04 to 3.23) in favour of in favour of the open suction group.

 suction group.

Duration of ventilation:

open endotracheal suctioning group: 3±2.5 days.

closed endotracheal suctioning group: 3±2.6 days

Contamination of the airways:

Open endotracheal suctioning: 1/39

Closed endotracheal suctioning: 3/41)

RR: 2.25 (95% CI 0.30 to 16.63) in favour of in favour of the open endotracheal suction group.

The authors conclude that In a unit with a low incidence of VAP, the effect of the endotracheal suction method alone did not impact the occurrence of VAP in the study population