Comparison of a Closed with an Open Endotracheal Suction: Costs and the Incidence of Ventilator-associated Pneumonia

비용, 인공환기관련폐렴 발생 빈도에 있어서의 개방 기관내 흡인술에 대한 폐쇄 흡인술의 비교

  • Jung, Jae Woo (Department of Internal Medicine, ChungAng University College of Medicine) ;
  • Choi, Eun Hee (Department of Medical Intensive Care Unit, ChungAng University Hospital) ;
  • Kim, Jin Hee (Department of Medical Intensive Care Unit, ChungAng University Hospital) ;
  • Seo, Hyo Kyung (Department of Medical Intensive Care Unit, ChungAng University Hospital) ;
  • Choi, Ji Yeon (Department of Medical Intensive Care Unit, ChungAng University Hospital) ;
  • Choi, Jae Cheol (Department of Internal Medicine, ChungAng University College of Medicine) ;
  • Shin, Jong Wook (Department of Internal Medicine, ChungAng University College of Medicine) ;
  • Park, In Won (Department of Internal Medicine, ChungAng University College of Medicine) ;
  • Choi, Byoung Whui (Department of Internal Medicine, ChungAng University College of Medicine) ;
  • Kim, Jae Yeol (Department of Internal Medicine, ChungAng University College of Medicine)
  • 정재우 (중앙대학교 의과대학 내과학교실) ;
  • 최은희 (중앙대학교병원 중환자실) ;
  • 김진희 (중앙대학교병원 중환자실) ;
  • 서효경 (중앙대학교병원 중환자실) ;
  • 최지연 (중앙대학교병원 중환자실) ;
  • 최재철 (중앙대학교 의과대학 내과학교실) ;
  • 신종욱 (중앙대학교 의과대학 내과학교실) ;
  • 박인원 (중앙대학교 의과대학 내과학교실) ;
  • 최병휘 (중앙대학교 의과대학 내과학교실) ;
  • 김재열 (중앙대학교 의과대학 내과학교실)
  • Received : 2008.06.26
  • Accepted : 2008.08.20
  • Published : 2008.09.30


Background: Tracheobronchial suctioning using the closed suctioning system has physiological benefits for critically ill patients. Despite these benefits, there are concerns about increased colonization of tracheobronchial tree by pathogenic organisms. The cost is another hinder to the introduction of closed suction system. The aim of this study was to evaluate the incidence of colonization and ventilator associated pneumonia and the cost-effectiveness of closed suction compared with open suction. Methods: During separated one month period, patients admitted MICU were cared by multiple-use, open suction, single-use, open suction and multiple-use, closed suction method, consecutively. Costs, colonization of tracheobronchial tree by MRSA and the incidence of ventilator-associated pneumonia (VAP) were analyzed. Results: One-hundred and six patients were enrolled. Twenty patients were treated with multiple-use, open suction, while 42 and 44 patients were cared with single-use, open catheter and multiple-use, closed catheter, respectively. Colonization by MRSA and the incidence of VAP were not different among three ways of suctioning. The overall costs per patient per day for suctioning were $10.58 for multiple-use, open suction, $28.27 for single-use, open suction and $23.76 for multiple-use, closed suction. Conclusion: Multiple-use, closed suctioning, when suction catheters were changed every 48 hrs, has the similar incidence of colonization of MRSA and occurrence of VAP and is a cost-efficient way of endotracheal suction.

연구배경: 폐쇄관을 이용한 기관내 흡인은 임상적으로 중한 환자에게 생리적인 이점이 있지만, 병원성 균주에 의한 기관지 내의 집락화가 증가될 수 있다는 보고가 있다. 비용증가는 폐쇄흡인의 또 다른 제한점이다. 본 연구는 폐쇄흡 인 및 개방흡인에 따른 병원균주의 집락화와 인공환기관련폐렴의 빈도와 가격효율성을 비교해보고자 시행되었다. 방 법: 각각 한 달의 간격을 사이에 두고 내과계 중환자실에 입원한 환자들을 대상으로 다중사용 개방흡인, 단일사용 개방흡인, 다중사용 폐쇄흡인을 순차적으로 시행하였다. 비용, MRSA의 기관지내 집락화, 인공환기폐렴의 발생 률을 분석하였다. 결 과: 106명의 환자가 연구 대상으로 포함이 되었고, 이 중 20명의 환자가 다중사용 개방흡인을, 42명이 단일사용 개방흡인을, 44명이 다중사용 폐쇄흡인술을 시행받았다. MRSA의 집락화와 인공환기관련폐렴의 빈도는 세 군간에 의미있는 차이를 보이지 않았다. 입원 일당 소모되는 비용은 다중사용 개방흡인이 $10.58, 단일사용 개방흡인이 $28.27, 다중사용 폐쇄흡인의 경우 $23.76인 것으로 나타났다. 결 론: 다중사용 폐쇄흡인을 매 48시간마다 교환하는 경우 MRSA 집락화와 인공환기폐렴 발생 빈도는 비슷하였고, 기관내 흡인술에 있어서 비용면에서도 효율적인 방법임을 알 수 있었다.



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