Closed versus open suctioning techniques

Airway suctioning is classically performed with the disconnection of the patient from the ventilator and the introduction of the suction catheter into the endotracheal tube. Alternatively, it can be accomplished with a closed suctioning system included in the ventilatory circuit, allowing to introduce the suction catheter into the airways without disconnecting the patient from the ventilator. The closed-suction system has some advantages compared to the conventional, open-suction technique. It can be helpful in limiting environmental, personnel and patient contamination and in preventing the loss of lung volume and the alveolar derecruitment associated with standard suctioning in the severely hypoxemic patients. However, the impact of the closed system on ventilator-associated pneumonia as well as its cost-effectiveness and the influence of such devices with ventilatory support remain to be assessed.