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CRITICAL CARE AND TRAUMA

Closed Suctioning System Reduces Cross-Contamination Between Bronchial System and Gastric Juices

Werner Rabitsch, MD^*, Wolfgang J. Köstler, MD^*, Wolfgang Fiebiger, MD^*, Christoph Dielacher, RN^*, Heidrun Losert, MD^*, Camillo Sherif, MD^*, Thomas Staudinger, MD^*, Edith Seper, Walter Koller, MD, Florian Daxböck, MD, Ernst Schuster, PhD, Paul Knöbl, MD^*, Heinz Burgmann, MD^*, and Michael Frass, MD^*

*Intensive Care Unit, Department of Internal Medicine I, Department of Hospital Hygiene, and Department of Medical Computer Sciences, University of Vienna, Vienna, Austria

Address correspondence and reprint requests to Michael Frass, MD, Intensive Care Unit, Department of Internal Medicine I, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Address e-mail to michael.frass{at}akh-wien.ac.at

In this prospective, randomized study, we evaluated whether a closed suctioning (CS) system (TrachCare^TM) influences crossover contamination between bronchial system and gastric juices when compared with an open suctioning system (OS). The secondary aims were an analysis of the frequency of ventilator-associated pneumonia (VAP) and an analysis of alteration in gas exchange. Antibiograms were performed from tracheal secretions and gastric juice aspirates on Days 1 and 3 of intubation in 24 patients in a medical intensive care unit. Five cross-contaminations were observed in the OS group on Day 3 versus Day 1; the 5 strains shared common genotypes as determined by random amplification of polymorphic DNA. No cross-contaminations were seen in the CS group (P = 0.037). VAP occurred in 5 patients of the OS group but in none of the CS group patients (P = 0.037). SpaO₂ decreased significantly in the OS group compared with presuctioning values—the opposite of the CS group. Whereas presuctioning values were comparable between groups, postsuctioning SpaO₂ was significantly higher in the CS group. CS significantly reduced cross-contamination between bronchial system and gastric juices and reduced the incidence of VAP when compared with OS. Hypoxic phases can be reduced by the help of CS.

IMPLICATIONS: This is the first prospective, randomized study comparing open versus closed suctioning with respect to microbiological cross-contamination between bronchial system and gastric juices and the incidence of ventilator-associated pneumonia in mechanically ventilated patients in the intensive care unit.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999