Closed tracheal suctioning systems in the era of COVID-19: is it time to consider them as a gold standard?

Tracheal suctioning is one of the most common activities performed in intensive care units (ICU) and is recognised as a high-risk procedure by the World Health Organization (WHO) and Centers for Disease Control (CDC). Aerosol-generating procedures on critical patients with COVID-19 present an increased risk of contamination for medical workers. In the time of the Sars-Cov-2 pandemic, with a massive number of patients with COVID-19 admitted to the ICU, the open tracheal suction technique (OTST) represents a serious threat for medical workers, even if they are wearing full personal protective equipment. Closed tracheal suction systems (CTSS) allow the removal of tracheobronchial secretions without disconnecting ventilatory circuits, preventing alveolar derecruitment, gas exchange deterioration and hypoxia. CTSS reduce the risk of pathogens entering the respiratory circuit and appear to be a cost-effective solution. CTSS should be considered mandatory for patients in the ICU with an artificial airway, in order to reduce bioaerosol exposure risk for medical workers and contamination of the surrounding environment.