Impact of closed versus open tracheal suctioning systems for mechanically ventilated adults: a systematic review and meta-analysis

Akira Kuriyama, Noriyuki Umakoshi, Jun Fujinaga, Tadaaki Takada

Research output: Contribution to journalReview articlepeer-review

21 Citations (Scopus)


Purpose: Whether closed tracheal suctioning systems (CTSS) reduce the incidence of ventilator-associated pneumonia (VAP) compared with open tracheal suctioning systems (OTSS) is inconclusive. We conducted a systematic review and meta-analysis of randomized controlled trials that compared CTSS and OTSS.

Methods: PubMed, the Cochrane Central Register of Controlled Trials, the Web of Science, Google Scholar, and a clinical trial registry from inception to October 2014 were searched without language restrictions. Randomized controlled trials of CTSS and OTSS that compared VAP in mechanically ventilated adult patients were included. The primary outcome was the incidence of VAP. Secondary outcomes were mortality and length of mechanical ventilation. Data were pooled using the random effects model.

Results: Sixteen trials with 1,929 participants were included. Compared with OTSS, CTSS was associated with a reduced incidence of VAP (RR 0.69; 95 % CI 0.54–0.87; Q = 26.14; I2 = 46.4 %). Compared with OTSS, CTSS was not associated with reduction of mortality (RR 0.96; 95 % CI 0.83–1.12; Q = 2.27; I2 = 0.0 %) or reduced length of mechanical ventilation (WMD −0.45 days; 95 % CI −1.25 to 0.36; Q = 6.37; I2 = 5.8 %). Trial sequential analysis suggested a lack of firm evidence for 20 % RR reduction in the incidence of VAP. The limitations of this review included underreporting and low quality of the included trials, as well as variations in study procedures and characteristics.

Conclusions: Based on current, albeit limited evidence, it is unlikely that CTSS is inferior to OTSS regarding VAP prevention; however, further trials at low risk of bias are needed to confirm or refute this finding.

Original languageEnglish
Pages (from-to)402-411
Number of pages10
JournalIntensive Care Medicine
Issue number3
Publication statusPublished - Mar 2015
Externally publishedYes


  • Adults
  • Closed tracheal suctioning systems
  • Endotracheal suctioning
  • Meta-analysis
  • Systematic review
  • Trial sequential analysis
  • Ventilator-associated pneumonia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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