The SPECIAL-ICU trial

Single-use versus multiple-use endotracheal suction catheters in mechanically ventilated ICU patients
Nurse using an endotracheal suction catheter
Title: Single-use versus MultiPlE-use endotracheal suCtIon cAtheters in mechanically ventiLated ICU patients: the SPECIAL-ICU trial
Funded by: The Egyptian Bureau for Cultural and Educational Affairs
Location: Plymouth
Dates: October 2022 – October 2026
¶¶Òõ¶ÌÊÓƵ PI: Mohamed Eid
 

Summary

Endotracheal suction catheters are often used multiple times during endotracheal suctioning procedures in resource-limited intensive care units (ICUs). The impact of this practice on mechanically ventilated patients' outcomes remains unclear.
This study will help ICU nurses to understand how different methods of endotracheal suctioning affects patients in ICUs with limited resources. The findings could influence clinical practice and improve patient outcomes.

Aims

The primary aim of this feasibility study with an embedded qualitative study is to determine the feasibility of investigating the effect of single-use endotracheal suction catheters or multiple-use endotracheal suction catheters flushed with chlorhexidine compared to multiple-use endotracheal suction catheters flushed with normal saline on ventilator associated pneumonia (VAP) incidence in mechanically ventilated patients and determine methods for the design of a conclusive randomised controlled trial (RCT).
 
 
 
 

Objectives

To be met in the feasibility randomised controlled trial study:
  • Assess the feasibility and acceptability of the trial procedures comparing the effect of single-use endotracheal suction catheters versus multiple-use endotracheal suction catheters flushed with chlorhexidine on VAP incidence in mechanically ventilated patients.
  • Select the most appropriate primary and secondary outcome measures to inform sample size calculation of the future RCT.
  • Identify confounding factors which might affect the future trial.
  • Assess patients' recruitment technique, follow-up rate, and any unexpected side effects of the intervention.
To be met within the embedded qualitative study:
  • Evaluate clinicians' willingness to identify, recruit and randomise eligible patients.
  • Explore the acceptability of the interventions to critical care nurses who will deliver it in the study settings.
  • Explore nurses' experiences in using chlorhexidine for flushing the suctioning circuit.
  • Explore nurses' experiences in using a single-used endotracheal suction catheter.
  • Explore the experiences of patients' next-of-kin in the process of recruitment and deferred consent.

Research outputs

Eid, M. H., Hambridge, K., Schofield, P. & Latour, J. M. (2025), 'Single-use versus multiple-use endotracheal suction catheters flushed with chlorhexidine in mechanically ventilated ICU patients: A study protocol of a feasibility randomized controlled trial with an embedded qualitative study', Nursing in Critical Care,
Eid, M. H., Hambridge, K., Schofield, P. & Latour, J. M., (2025), 'Sustainability in ICU: Less plastic, greener future – Response to Lucchini et al.', Intensive and Critical Care Nursing,
Eid, M. H., Hambridge, K., Schofield, P. & Latour, J. M. (2024), 'A scoping review to map the implications of reusing single-use endotracheal suctioning catheter practices in mechanically ventilated patients', Intensive and Critical Care Nursing,
 
 
 

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nurse shows other trainees how to use the IV drip