closedsuction

Closed suction, also written as closed suction system, is a method and device arrangement used to remove secretions from the airway of patients who are intubated or have a tracheostomy and are typically mechanically ventilated. The system is inline with the ventilator circuit and allows suctioning without disconnecting the airway tubing.

A closed suction catheter is enclosed within a protective sleeve and connects to suction; it can be advanced through the endotracheal or tracheostomy tube to aspirate secretions while the patient remains on ventilation. This preserves oxygenation and humidification and reduces disruption of the ventilator circuit.

Indications include accumulation of secretions that threaten airway patency, thick mucus, or if frequent suctioning is required. The procedure involves pre-oxygenating the patient, attaching the closed suction catheter to the suction source, inserting the catheter through the endotracheal/tracheostomy tube, applying suction while withdrawing the catheter for about 10 to 15 seconds, and avoiding suctioning during the next breath when possible. Typical suction pressures range from about 100 to 150 mmHg in adults, with lower values used in children.

Advantages include maintenance of PEEP and FiO2, reduced atmospheric contamination and ventilator circuit disconnections, and potential reductions in ventilator-associated pneumonia in some studies. Risks include hypoxemia, airway trauma, bronchospasm, mucosal injury, and infection if aseptic technique is not observed. Evidence from trials and meta-analyses is mixed, with some reporting a benefit in VAP rates and others finding no significant difference.

Closed suction is standard in many intensive care and anesthetic settings as part of airway hygiene and airway management for intubated or tracheostomized patients.