Comparative effectiveness of open vs. closed endotracheal suctioning techniques in mechanically ventilated adults

Background: Airway suctioning is used in managing mechanically ventilated patients. Two primary techniques are used: open tracheal suction systems (OTSS) and closed tracheal suction systems (CTSS). While both methods maintain airway patency and prevent complications (hypoxemia and ventilator-associated pneumonia (VAP)), their comparative clinical effectiveness is under debate. In this systematic review we aimed to compare the clinical outcomes of OTSS and CTSS in mechanically ventilated adult patients, focusing on physiological stability, VAP incidence, pain and agitation levels, suctioning duration, and cost-effectiveness. Methods: A comprehensive search was conducted in PubMed, Scopus, and Google Scholar. Studies were included if they involved adult patients (≥18 years) undergoing mechanical ventilation and compared OTSS and CTSS. Outcomes assessed included oxygen saturation, hemodynamic changes, VAP incidence, suction duration, pain scores, and economic cost. We include randomized controlled trials, quasi-experimental studies, and clinical trials. Data synthesis was performed qualitatively in accordance with PRISMA guidelines. Results: Eight studies met the inclusion criteria. The majority show no significant differences in VAP incidence or mortality between OTSS and CTSS. CTSS was associated with better maintenance of oxygen saturation, shorter suctioning time, improved cardiorespiratory stability, and in some cases, reduced pain scores. There is a higher per-unit costs for CTSS, though long-term use without daily replacement rendered it more cost-effective in patients ventilated for over four days. Conclusion: Both OTSS and CTSS are clinically effective in secretion management, CTSS offers advantages in maintaining physiological stability and reduce procedural disruptions. These benefits must be weighed against increased equipment costs and the potential for infection-related complications such as IVAC. The choice between CTSS and OTSS should be individualized based on patient condition, clinical context, and resource availability.