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Endotracheal suctioning of patients on a ventilator is an important aspect of pulmonary care.  There is debate whether open suctioning (disconnecting the ventilator from the ETT) or closed suctioning (using a system that is integrated into the circuit) leads to better outcomes. Find a comparison below:

- No need to disconnect patient from ventilator --> less derecruitment

- Less staff needed to perform suction

- Less cardiovascular side effects in children with unstable circulation 

- Less glove contamination of staff and therefore less risk of transmission of microorganisms

- No difference to open suction with regards to VAP or mortality

Closed Suctioning

Open Suctioning

- Need for 2 staff to do procedure

- Risk of derecruitment due to need for disconnection

- No difference in VAP-rate or mortality 

- More cardiovascular side effects in children with unstable circulation

- Option to use T-piece / bag --> Recruitment manoeuvre

- More cardiovascular side effects (hypertension, tachycardia, bradycardia, desaturation) 

- Option to instill saline (in case of tough secretions or bleeding)

Intensive Care NSW has the following comparison table available:

ETT Suctioning Evidence
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