A Trial Will Study How to Improve Pneumonia Prevention in Mechanically Ventilated Patients

The Spanish Society of Intensive Care Nursing and Coronary Units (SEEIUC) has awarded the 2026 SEEIUC Research Grant to the project “Secretion Suctioning and Ventilator-Associated Pneumonia: Technique and System,” led by PhD candidate Àngels Aloy Orozco, a researcher with the Nursing Care research group at the Sant Pau Research Institute (IR Sant Pau). The study will compare the two systems used to suction respiratory secretions in patients undergoing invasive mechanical ventilation—the open and closed systems—to determine which is more effective in preventing pneumonia, provides greater safety, and enables the more efficient use of healthcare resources.

“Secretion suctioning is a very common intervention in the care of critically ill patients, but uncertainty remains whether the closed system provides clinical advantages over the open system. Answering this question could help us make better-informed decisions and standardize the care these patients receive,” explains Aloy.

Removing Secretions to Reduce the Risk of Pneumonia

Invasive mechanical ventilation requires inserting a tube into the trachea, which disrupts the respiratory system’s natural defense mechanisms. Intubated patients have greater difficulty coughing and clearing mucus, allowing secretions to accumulate in the airway and making it easier for microorganisms to reach the lungs, thereby increasing the risk of developing pneumonia.

To prevent this buildup, keep the airway clear and reduce the risk of infection; nursing staff periodically suction secretions through the endotracheal tube. This is an essential procedure in the care of mechanically ventilated patients, but the way it is performed can affect both its effectiveness and the occurrence of adverse events.

Suctioning can be performed using an open system, which requires briefly disconnecting the patient from the ventilator, or a closed system, which allows secretions to be removed without interrupting ventilation. Although both systems are used in clinical practice, the available evidence still does not clearly establish whether one is more effective in preventing ventilator-associated pneumonia.

This infection can develop 48 hours or more after invasive ventilation begins and is one of the most common infections acquired in intensive care units (ICUs). It is associated with longer periods of mechanical ventilation, prolonged hospital stays, more complications, and greater use of healthcare resources.

Training, Clinical Trial, and Economic Evaluation

The project will be conducted in three consecutive phases. The first will consist of a training intervention for ICU nursing staff aimed at updating their knowledge and standardizing the secretion suctioning technique before the comparison of the two systems begins.

“To obtain reliable results, comparing two devices is not enough. We must first ensure that the technique is applied consistently and in accordance with the available evidence. That is why training nursing staff is an essential part of the research design itself,” the researcher notes.

The second phase will be a randomized controlled clinical trial expected to include more than 400 adult patients whose mechanical ventilation is estimated to last more than 48 hours. Participants will be randomly assigned to undergo suctioning using either the open or closed system.

The primary outcome will be the incidence of ventilator-associated pneumonia, diagnosed according to the criteria established by the Pneumonia Zero program. The study will also analyze the time to infection onset, the number of suctioning procedures performed, the duration of mechanical ventilation, and potential adverse events, including decreases in oxygen saturation, changes in heart rate, and fluctuations in blood pressure.

Finally, a third phase will evaluate the direct healthcare costs associated with each system and calculate their cost-effectiveness. The study will therefore determine not only whether one alternative improves clinical outcomes but also whether its potential benefits justify the resources required to implement it.

Nursing Evidence With Direct Application in the ICU

The project combines clinical research, professional training, and economic evaluation to examine a routine intervention with a direct impact on the safety of critically ill patients. Its findings could help reduce variability in clinical practice and provide a basis for revising secretion suctioning and infection prevention protocols in intensive care units.

The project also includes plans to disseminate the findings through scientific publications and conference presentations and to translate them into clinical practice by updating protocols and developing new training activities for healthcare professionals.

“The ultimate goal is not to prove that one system is inherently better, but to identify which option provides the greatest benefit to patients and enables resources to be used more efficiently. Generating robust evidence about an intervention we perform every day can directly lead to safer, higher-quality care,” concludes Aloy.