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array:23 [ "pii" => "S0300289623003782" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.11.010" "estado" => "S300" "fechaPublicacion" => "2024-02-01" "aid" => "3439" "copyright" => "The Author(s)" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2024;60:116-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0300289623004167" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.12.011" "estado" => "S300" "fechaPublicacion" => "2024-02-01" "aid" => "3457" "copyright" => "The Author(s)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2024;60:119-21" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "COPD Patients Display Increased Peripheral Blood Somatic Mutations Which Associate With the Prevalence of Co-morbidities" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "119" "paginaFinal" => "121" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3290 "Ancho" => 2925 "Tamanyo" => 578673 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Higher prevalence of somatic mutations in COPD patients compared to healthy controls and associations with COPD co-morbidities. (A) Flow chart of differentially prevalent mutated genes identified in our study. (B) The top-10 genes that displayed the highest differential prevalence of somatic mutations in COPD patients compared to healthy controls. The white bars represent the percentage of the COPD group that had a putative somatic mutation within the gene, the gray bars represent the percentage of mutations within the control group. The delta between percentage mutations in the COPD and control group is depicted above the white bars. (C) The prevalence of gene mutations of <span class="elsevierStyleItalic">HLA-A</span>, <span class="elsevierStyleItalic">LGALS9C</span>, <span class="elsevierStyleItalic">ORT2T</span> or <span class="elsevierStyleItalic">KIF26B</span> in COPD patients (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>165) with or without osteoporosis (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15), hypertension (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>51) or myocardial infarction (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11). (D) The gene expression levels of <span class="elsevierStyleItalic">HLA-A</span> and <span class="elsevierStyleItalic">MRPL4</span> in COPD patients (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>165) with or without osteoporosis (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15) or hypertension (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>51). The somatic mutation data was obtained from peripheral blood, while the gene expression data was obtained from bronchial biopsies. Statistical differences were tested using a Mann–Whitney <span class="elsevierStyleItalic">U</span> test, nominal <span class="elsevierStyleItalic">p</span> values are shown on top of the graph.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alen Faiz, Valerie R. Wiersma, Jonas B. Salzbrunn, Corry-Anke Brandsma, Wim Timens, Janette K. Burgess, Maarten van den Berge, Dirk-Jan Slebos, Victor Guryev, Simon D. Pouwels" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Alen" "apellidos" => "Faiz" ] 1 => array:2 [ "nombre" => "Valerie R." "apellidos" => "Wiersma" ] 2 => array:2 [ "nombre" => "Jonas B." "apellidos" => "Salzbrunn" ] 3 => array:2 [ "nombre" => "Corry-Anke" "apellidos" => "Brandsma" ] 4 => array:2 [ "nombre" => "Wim" "apellidos" => "Timens" ] 5 => array:2 [ "nombre" => "Janette K." "apellidos" => "Burgess" ] 6 => array:2 [ "nombre" => "Maarten" "apellidos" => "van den Berge" ] 7 => array:2 [ "nombre" => "Dirk-Jan" "apellidos" => "Slebos" ] 8 => array:2 [ "nombre" => "Victor" "apellidos" => "Guryev" ] 9 => array:2 [ "nombre" => "Simon D." "apellidos" => "Pouwels" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623004167?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000002/v3_202406051408/S0300289623004167/v3_202406051408/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0300289623004088" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.12.006" "estado" => "S300" "fechaPublicacion" => "2024-02-01" "aid" => "3452" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2024;60:115" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Large Cystic Bronchiectasis: A Differential Diagnosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "115" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1043 "Ancho" => 1119 "Tamanyo" => 216035 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Voluminous cystic formation with air-fluid level content that occupies more than 1/3 of the left hemithorax in the posteroanterior projection of the chest X-ray; (B) CT scan coronal plane, showing the displacement and compression of vascular structures due to the pulmonary cystic lesion; (C) CT scan axial plane at the level of T6; (D) lateral projection of the chest X-ray; (E) CT scan sagittal plane; (F) CT scan axial plane in soft tissue window; (G) chest X-ray performed 5 months after surgery; (H) in the segmentectomy specimen, a unilocular cystic cavity with a maximum diameter of 65<span class="elsevierStyleHsp" style=""></span>mm was recognized, which was focally in connection with a bronchus (red arrow); (I) this cavity was lined by bronchial respiratory type epithelium (blue arrow), with residual smooth muscle fibers (green arrow) and marked underlying chronic inflammation (yellow arrow), characteristic findings of cystic bronchiectasis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pablo Andrés Ordóñez Lozano, Juan Medrano Ruiz, Humberto Rey Gutama" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Pablo Andrés" "apellidos" => "Ordóñez Lozano" ] 1 => array:2 [ "nombre" => "Juan" "apellidos" => "Medrano Ruiz" ] 2 => array:2 [ "nombre" => "Humberto" "apellidos" => "Rey Gutama" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623004088?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000002/v3_202406051408/S0300289623004088/v3_202406051408/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Closed Suction System in Tracheal Suctioning in the Critically Ill Patient Connected to Mechanical Ventilation: A Systematic Review" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Director</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "116" "paginaFinal" => "118" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carmen Amaia Ramírez-Torres, Elena Andrade-Gómez, Marta Giménez-Luzuriaga, Carmen Lozano, Esther Sapiña-Beltrán" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Carmen Amaia" "apellidos" => "Ramírez-Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Elena" "apellidos" => "Andrade-Gómez" "email" => array:1 [ 0 => "elena.andrade@unirioja.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Marta" "apellidos" => "Giménez-Luzuriaga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Carmen" "apellidos" => "Lozano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Esther" "apellidos" => "Sapiña-Beltrán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Predepartment of Nursing, Faculty of Health Sciences, University of La Rioja, Logroño, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Area of Biochemistry and Molecular Biology, OneHealth-UR Research Group, University of La Rioja, Logroño, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2043 "Ancho" => 2423 "Tamanyo" => 369598 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PRISMA flow diagram.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In all health systems around the world, intensive care unit (ICU) beds are essential<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a>. Nowadays, we are facing an aging population, and it has been estimated that in 2050 in Europe, the percentage of the population that will be 80 years old or older will represent nearly 10%, and only with these patients will comprise 10–20% of all ICU admissions<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a>. It is important to be prepared for this situation, being necessary to innovate in medical technology and establish standard care procedures.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In adult patients connected to mechanical ventilation (MV), tracheal suctioning is a common care realized by nursing personnel. This procedure consists of inserting the probe of an open suction system (OSS) or closed suction system (CSS) through the endotracheal tube to remove secretions to avoid discomfort and occlusion of the airway.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> Tracheal suctioning practices can increase the rates of cross-contamination that triggers ventilator-associated pneumonia (VAP).<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> VAP is defined as pneumonia that develops in an intubated patient after 48<span class="elsevierStyleHsp" style=""></span>h or more of MV support.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6,7</span></a> VAP has an impact on morbidity, days of stay in ICU (up to 13 days more), treatment (more antibiotics), and mortality (increases by 9.4%).<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">CSS is the gold standard for tracheal suctioning in many countries, but COVID-19 caused an increase in their use in those countries where CSS was still not used.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> However, there is still no clear evidence that the benefits outweigh the risks using CSSs. It is obvious that it can be used to control patients with contagious diseases. In these cases, it is important its use as protection for health personnel.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> However, there are still many variables and relevant aspects that must be analyzed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">This study aimed to explore the evidence surrounding the two different methods for tracheal aspiration to determine if CSS has better results than OSS in adult patients connected to MV, due to it is not yet as explored field.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a systematic review registered in The International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023401103). All eligible primary research studies and literature reviews containing outcomes of bacterial colonization of tracheal aspiration with a CSS in patients connected to mechanical ventilation admitted to an ICU were included. The tracheal suction included was both emergency and programmed. Only articles published with free full text in English or Spanish were included in the review (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A total of four studies were included in the review (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Regarding the antibiotics use, Jongerden et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> found that 75% of the patients with CSS were treated with antibiotics, while 73% of patients with OSS. In both groups, patients with CSS and patients with OSS, the most common antibiotic density was in penicilin-like antibiotics and cephalosporins. Rabitsch et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> did not found significant differences in antibiotic patterns between groups.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Jongerden et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> found <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>, <span class="elsevierStyleItalic">Acinetobacter</span> species, or <span class="elsevierStyleItalic">Enterobacter</span> species in 58% of the patients with CSS, compared to 60% of the patients with OSS. In patients with CSS, <span class="elsevierStyleItalic">P. aeruginosa</span> and <span class="elsevierStyleItalic">Enterobacter</span> species appeared less frequently (10.3 vs. 15.7 and 0.2 vs. 1.0) but the presence of <span class="elsevierStyleItalic">Acinetobacter</span> species was higher (2.7 vs. 0.4). The overall acquisition was 35.5 and 32.5 per 1000 patient-days during CSS and OSS, respectively. However, Siempos et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> included research that found significant differences in colonization rates between groups related to <span class="elsevierStyleItalic">P. aeruginosa</span> (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01) and <span class="elsevierStyleItalic">Acinetobacter</span> species (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01) that were more frequent in CSS than in the OSS.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Siempos et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> included research from Rabitsch et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> found significant differences between groups. Five cross-contaminations occurred in the patients with OSS but not in the patients with CSS. The cross-contamination occurred from bronchial to gastric juice in either direction. The cultures showed <span class="elsevierStyleItalic">Candida albicans</span>, <span class="elsevierStyleItalic">Enterococcus faecalis</span>, and <span class="elsevierStyleItalic">Candida tropicalis</span> cross-contamination.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Siempos et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> included research from Lorente et al.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> did not found significant differences between groups with CSS and OSS, but <span class="elsevierStyleItalic">P. aeruginosa</span>, <span class="elsevierStyleItalic">Enterobacter</span> species, and <span class="elsevierStyleItalic">Serratia marcescens</span> were more frequent in patients with CSS. <span class="elsevierStyleItalic">Haemophilus</span> species were more frequent in the group with OSS. They detailed the bacteria that developed VAP. The microorganisms appeared equal in patients with CSS and OSS; the most common were the Gram-negative bacteria, non-fermentative Gram-negative bacteria, <span class="elsevierStyleItalic">Staphylococcus aureus</span>, and Gram-positive <span class="elsevierStyleItalic">cocci</span>, respectively.</p><p id="par0050" class="elsevierStylePara elsevierViewall">According to the cross-contamination, the incidence of VAP found by Lorente et al.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> was observed in patients with OSS and cross-contamination. Vonberg et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> found less risk ratio (RR) of VAP using CSS in six of the nine studies included, but these studies did not show significant differences. However, other studies have not found differences in the incidence density of VAP.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8,9,11</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">This review provides conflicting results around bacterial colonization in adult patients connected to MV. The absolute recommendation of the use of CSS in all ICU patients connected to MV cannot be generalized.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Bardi et al.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> in 2021 found pneumonia appeared in 23% of critically ill patients, Johnstone et al.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> in 2023 showed the associated mortality of VAP at around 30–36%; therefore, there is an urgent need to strengthen the surveillance of patients with mechanical ventilation. For example, the risk of death increased with <span class="elsevierStyleItalic">P. aeruginosa</span> (OR 1.39 [95% CI, 1.05–1.83])<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> and <span class="elsevierStyleItalic">Acinetobacter</span> species (OR, 1.40 [95% CI, 1.08–1.81).<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Nursing personnel must be careful when using OSS and CSS. Cobley et al.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> in 1991 showed that the potential advantages of CSS would be related to the maintenance of ventilator parameters. Yazdannik<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> in 2013 said that it had not found significant differences in the reduction of contamination with potentially infectious organisms, but currently there is no clear evidence either.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Nowadays, we can only suggest the use of CSS in cases of respiratory infections like SARS-CoV-2 that could be spread from person to person primarily through large-particle respiratory droplet transmission and patient with a high risk of de-recruitment.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In addition, the future of research could be related to new concepts like multidrug-resistant bacteria and their influence,<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> probiotics for preventing VAP<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> and other important aspects of ICU patients like nutrition, designed with a randomized clinical trial.</p><p id="par0080" class="elsevierStylePara elsevierViewall">There is a necessity to update the use of CSS vs. OSS marking differences between patient and health care institutions, including patient variables such as cross-contamination, VAP, cardiorespiratory variables, and organization variables such as training, cost-effectiveness use, occlusion of endotracheal tubes, and environmental contamination. This type of research would be led by a multidisciplinary team because there are many professionals involved in tracheal suctioning.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0085" class="elsevierStylePara elsevierViewall">This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of Interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of Interest" ] 2 => array:2 [ "identificador" => "xack749497" "titulo" => "Acknowledgment" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2043 "Ancho" => 2423 "Tamanyo" => 369598 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PRISMA flow diagram.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: CSS: closed suctioning system; ICU: intensive care unit; MV: mechanical ventilation; OS: opening suctioning system; RCT: randomized controlled-trial; VAP: ventilator-associated pneumonia.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Authors and Year \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sample \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Design \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Population \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Objective \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vonberg RP. 2006<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1292(648 OS vs. 644 CS)(9 RCTs) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meta-analysis of RCTs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients in ICU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To analyze the effect of the type of suctioning system on the incidence of VAP. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">648 patients were treated with OSS, of whom 20% acquired VAP.644 patients were treated with a CSS, and 19% acquired VAP.CSS presents some advantages in handling compared to open systems. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Siempos I. 2008<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1292(9 RCTs) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meta-analysis of RCTs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients requiring MW \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To assess the evidence of CSS, prevent VAP. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">There was no difference in the incidence of VAP between patients suctioned with CSS or OSS. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Jongerden IP. 2011<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1110(585 CS vs. 525 OS) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Crossover study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients in ICU >24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To determine whether CSS vs. OSS reduces the incidence of cross-transmission of Gram-negative bacteria in the ICU. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37% of the patients acquired colonization with at least one of the marker pathogens in both CSS and OSS.Implementation of CSS failed to reduce cross-transmission and acquisition rates of the most relevant Gram-negative bacteria in ICU patients. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Faradita D. 2018<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1225(615 OSS vs. 610 CSS)(5 RCTs) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meta-analysis of RCTs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients in ICU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To compare CSS vs. OSS in relation to CAP in adult ICU patients. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A total of 615 patients were treated with an open endotracheal suctioning system, of which 29% acquired VAP, and 610 patients were treated with a closed endotracheal suctioning system, of which a similar 29% suffered VAP. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3559166.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Selected Articles.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "National Healthcare Safety Network (NHSN). 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