Design: Single-centre randomised controlled trial
Population: 60 ventilated ARDS patients on PEEP 5 to 10 cmH2O
Primary outcome: End-expiratory lung impedance change and oxygenation after suctioning
Effect: Global ΔEELI at 1 min −0.54 (closed) vs −2.32 (open), P<0.001; no outcome differences

A single-centre trial randomised 60 ventilated patients with ARDS on PEEP of 5 to 10 cmH2O to open or closed endotracheal suctioning, measuring lung volume with electrical impedance tomography.

Closed suctioning led to much less loss of end-expiratory lung impedance at 1 and 10 minutes, and SpO2 at 1 minute was higher (99.0% vs 98.1%). However, lung volume recovered faster after open suctioning, returning to baseline by 20 minutes versus 30 minutes. Oxygenation index at 30 minutes, extubation and survival did not differ.

The physiological differences are short-lived and the trial too small for outcomes. It supports closed suctioning where derecruitment is a concern, as in more severe ARDS.

Consider closed suctioning in ARDS patients prone to derecruitment
Expect brief falls in lung volume and saturation with open suctioning
Suction only when needed rather than on a fixed schedule
Allow time for recovery and consider a recruitment manoeuvre if desaturation persists

Why it matters

It offers physiological support for a common ICU practice choice.

The statistics, in plain English

The saturation difference of about 1 percentage point at 1 minute is statistically significant but clinically small. Outcome comparisons are underpowered with 60 patients.