OBJECTIVE: The aim of this study was to analyze the prevalence of ventilator-associated pneumonia (VAP) using a closed-tracheal suction system versus an open system. DESIGN: Prospective and randomized study, from October 1, 2002, to December 31, 2003. SETTING: A 24-bed medical-surgical intensive care unit in a 650-bed tertiary hospital. PATIENTS: Patients requiring mechanical ventilation for > 24 hrs. INTERVENTIONS: Patients were randomized into two groups; one group was suctioned with the closed-tracheal suctioning system and another group with the open system. MEASUREMENTS: Throat swabs were taken at admission and twice a week until discharge to classify pneumonia in endogenous and exogenous. MAIN RESULTS: A total of 443 patients (210 with closed-tracheal suction system and 233 with the open system) were included. There were no significant differences between groups of patients in age, sex, diagnosis groups, mortality, number of aspirations per day, and Acute Physiology and Chronic Health Evaluation II score. No significant differences were found in either the percentage of patients who developed VAP (20.47% versus 18.02%) or in the number of VAP cases per 1,000 mechanical ventilation-days (17.59 versus 15.84). There were also no differences in the VAP incidence by mechanical ventilation duration. At the same time, we did not find any differences in the incidence of exogenous VAP. Likewise, there were also no differences in the microorganisms responsible for pneumonia. Patient cost per day for the closed suction was more expensive than the open suction system ($US11.11 +/- $US2.25 versus $US2.50 +/- $US1.12, p < 0.001). CONCLUSION: We conclude that in our study, the closed-tracheal suction system did not reduce VAP incidence, even for exogenous pneumonia.

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