Ventilator-associated pneumonia (VAP) emerges as a hospital-acquired infection affecting the lower respiratory tract in individuals on mechanical ventilation, typically manifesting >or = 48 hours after ventilation initiation. Its correlation with prolonged ventilator reliance, extended stays in intensive care and hospitals, increased mortality rates, and substantial financial burdens is evident.

Infants and children on artificial airways necessitate endotracheal suctioning to clear secretions and avert airway blockages. Within pediatric intensive care units (PICUs), two primary suctioning systems are used commonly: open endotracheal suctioning (OES), which requires disconnection using single-use catheters, and closed-system suctioning (CSS), utilizing multiple-use in-line catheters that permit uninterrupted mechanical ventilation during suctioning. CSS proposes potential advantages including enhanced physiological stability and reduced infection risks by eliminating environmental contamination of the catheter before its introduction into the endotracheal tube and by limiting the dispersal of infectious mucus particles. Despite these suggestions, the recommendation of CSS as a preventive measure for pediatric VAP lacks substantial supporting evidence.

Despite meta-analyses and randomized controlled trials revealing no significant disparities between OES and CSS in VAP occurrence among adults and neonates, clear evidence in the pediatric age group is presently lacking.