背景：呼吸器相關肺炎佔醫療照護相關感染達8-15%，使用呼吸器超過 8-10 天，發生呼吸器相關肺炎更高達90%。臨床抽痰方式多使用開放式抽痰系統；除非有飛沫傳染之疑慮時需使用密閉式抽痰系統，此可減少抽痰時斷開呼吸器及氣管內管，維持完整的密閉無菌系統、並能維持心律及血氧。
目的：探討密閉式抽痰系統與開放式抽痰系統對加護病房內氣管內管放置及呼吸器使用的病人於降低呼吸器相關肺炎之效果。
方法：搜尋2014-2019 的資料庫，包括 PubMed、Medline、CINAHL、SCOPUS，限定系統性回顧（Systematic review）、英文全文。關鍵字：加護病房（Intensive care unit）、呼吸器（Ventilator）、氣管內管（Endotracheal tube）、密閉式抽痰系統（Close tracheal suctioning system）、開放式抽痰系統（Open tracheal suctioning systems）、呼吸器相關肺炎（Ventilator- associated pneumonia）。
結果：密閉式抽痰系統較開放式抽痰系統可降低 30% 呼吸器相關肺炎的發生率，但在死亡率及呼吸器使用天數上並無差異。於2019 年10 月至2019 年12 月實際於加護病房收案2 人，兩種抽痰系統在呼吸器相關肺炎的發生率並無差異，實證應用後發現兩者皆未發生呼吸器相關肺炎，臨床實作結果與文獻一致。
結論：文獻指出密閉式抽痰系統在降低呼吸器相關肺炎發生率效果佳；另有文獻指出兩種抽痰系統在降低呼吸器相關肺炎的發生率並無差異。兩者在使用上各有優缺點，開放式抽痰系統無須另外支付費用可減少經濟負擔；建議使用密閉式抽痰系統以減少在抽痰過程的痰液飛濺、降低感染風險及無血氧和心律變化的影響。

Background: Among cases of healthcare-associated infection in the intensive care unit, ventilator-associated pneumonia (VAP) accounts for 8%–15%. If the ventilator is used for more than 8–10 days, the occurrence of VAP increases up to 90%. The endotracheal tube and ventilator should be kept in a closed system to prevent infection, their suction process should follow an aseptic technique, and mechanical damage should be avoided. Due to considerations in clinical cost, the open tracheal suctioning systems (OTSS) are often used for suction. However, closed tracheal suctioning systems (CTSS) are also required although they are associated with the risk of droplet infection; CTSS can reduce the disconnection of the ventilator and the endotracheal tube due to suction. Moreover, it maintains a completely closed sterile system as well as heart rhythm and blood oxygen.
Methods: A search was conducted on databases from 2014 to 2019, including PubMed, Medline, CINAHL, and SCOPUS. The search was limited to systematic reviews and full texts in English. Keywords used were “intensive care unit (ICU),” “ventilator or ventilation,” “endotracheal intubation,” “close tracheal suctioning systems (CTSS),” “open
tracheal suctioning systems (OTSS),” and “ventilator-associated pneumonia (VAP).”
Results: A review and appraisal of the literature on the reduction of VAP infection rate showed that the effect of CTSS can reduce VAP incidence by 30% compared with OTSS. Furthermore, no differences in mortality and hospitalization duration among the patients using CTSS or OTSS were observed. From October 2019 to December 2019, two patients were assessed in the ICU to compare CTSS and OTSS in VAP, and no difference in VAP incidence was observed.
Discussion and conclusion: The literature indicates that CTSS has a better effect on reducing VAP incidence. Conversely, other literature has indicated that there is no difference between OTSS and CTSS in reducing VAP incidence. We found that neither of them induces VAP in the practical setting. Therefore, our study is consistent with the literature. Both OTSS and CTSS have their own advantages and disadvantages. OTSS reduces financial burden, without incurring additional costs. However, CTSS is recommended because the suction process can reduce the risk of sputum splashing and infection and can avoid changes in the blood oxygen and heart rhythm. This evidence-based study supports the clinical application of the two suctioning systems.