The effects of open and closed suctioning systems on neonatal pain and vital signs in neonatal intensive care units.

BACKGROUND: Endotracheal suctioning is a procedure used by neonatal intensive care unit nurses to maximize oxygenation and clear airways of secretions, and is one of the most common painful procedures causing stress in intubated newborns. AIM: This aim of this study is to compare the effects of open and closed endotracheal suctioning on pain, peak heart rate and oxygen saturation in neonates on mechanicalventilation. MATERIALS AND METHODS: This experimental-design study was conducted on 30 newborns who were mechanically ventilated in the tertiary neonatal intensive care unit of a public hospital. First, closed suctioning and then open suctioning was performed on patients during the day. Pain, peak heart rate and oxygen saturation levels were evaluated before, during and 30 min after each suctioning procedure. RESULTS: Of the newborns included in the study, 53.3 % were male and 36.6 % were admitted to intensive care unit due to a heart defect. No statistically significant differences were found in pain, peak heart rate, or oxygen saturation between the open and closed suctioning methods. However, oxygen saturation levels during suctioning were lower compared to levels before and 30 min after the procedure. Additionally, peak heart rate was lower during suctioning compared to 30 min afterward. CONCLUSIONS: The study concludes that there is no significant difference between open and closed suctioning techniques concerning pain, peak heart rate, and oxygen saturation. IMPLICATIONS TO PRACTICE: Given its sterility and ease of use, the closed suction method may be preferable in clinical settings.

Critical Assessment of Information Back-Flow in Measurement-Free Teleportation.

We assess a scheme for measurement-free quantum teleportation from the perspective of the resources underpinning its performance. In particular, we focus on claims recently made about the crucial role played by the degree of non-Markovianity of the dynamics of the information carrier whose state we aim to teleport. We prove that any link between the efficiency of teleportation and the back-flow of information depends fundamentally on the way the various operations entailed by the measurement-free teleportation protocol are implemented while-in general-no claim of causal link can be made. Our result reinforces the need for the explicit assessment of the underlying physical platform when assessing the performance and resources for a given quantum protocol and the need for a rigorous quantum resource theory of non-Markovianity.

The Impact of Open versus Closed Computer-Aided Design/Computer-Aided Manufacturing Systems on the Marginal Gap of Zirconia-Reinforced Lithium Silicate Single Crowns Evaluated by Scanning Electron Microscopy: A Comparative In Vitro Study.

This study aimed to compare the impact of CAD/CAM closed systems and open systems on the marginal gap of monolithic zirconia-reinforced lithium silicate (ZLS) ceramic crowns, as both systems are used in everyday dentistry, both chair-side and laboratory. For the closed system, 20 plastic teeth were scanned by a Primescan intra-oral scanner (IOS), and for the open system, the same number of plastic teeth were scanned by Trios 4 IOS. For the closed system, CEREC software was used, and for the open system, EXOCAD software was used. All 40 ZLS crowns were grinded by the same four-axis machine and cemented with Temp-bond, followed by self-adhesive resin cement. For each type of cement, an evaluation of the marginal gap was conducted by scanning electron microscopy (SEM). Before comparisons between the groups, a Kolmogorov-Smirnov test was performed on the study variables showing a normal distribution (p > 0.05). Independent T tests (α = 0.05) and paired-sample T tests (α = 0.05) were used. The independent T test found no significant mean marginal gap differences in the zirconia-reinforced lithium silicate crowns bonded with Temp-bond and scanned by Primescan (28.09 µm ± 3.06) compared to Trios 4 (28.94 µm ± 3.30) (p = 0.401), and there was no significant mean marginal gap differences in zirconia-reinforced lithium silicate crowns bonded with self-adhesive resin cement (Gcem ONE) and scanned by Primescan (46.70 µm ± 3.80) compared to Trios 4 (47.79 µm ± 2.59) (p = 0.295). Paired-sample T tests showed significantly higher mean marginal gaps with Gcem ONE compared to Temp-bond for the total mean marginal gap when scanning with Primescan (p = 0.0005) or Trios 4 (p = 0.0005). In everyday dentistry, both closed systems (Primescan with Cerec) and open systems (Trios 4 with Exocad) can be used to achieve an acceptable (<120 µm) marginal gap for ZLS CELTRA® DUO single crowns. There is a significant difference between cementation with Temp-bond and Gcem ONE self-adhesive resin cement (p < 0.05).

Experimental Identification of Potential Martian Biosignatures in Open and Closed Systems.

NASA's Perseverance and ESA's Rosalind Franklin rovers have the scientific goal of searching for evidence of ancient life on Mars. Geochemical biosignatures that form because of microbe-mineral interactions could play a key role in achieving this, as they can be preserved for millions of years on Earth, and the same could be true for Mars. Previous laboratory experiments have explored the formation of biosignatures under closed systems, but these do not represent the open systems that are found in natural martian environments, such as channels and lakes. In this study, we have conducted environmental simulation experiments using a global regolith simulant (OUCM-1), a thermochemically modelled groundwater, and an anaerobic microbial community to explore the formation of geochemical biosignatures within plausible open and closed systems on Mars. This initial investigation showed differences in the diversity of the microbial community developed after 28 days. In an open-system simulation (flow-through experiment), the acetogenic Acetobacterium (49% relative abundance) and the sulfate reducer Desulfosporomusa (43% relative abundance) were the dominant genera. Whereas in the batch experiment, the sulfate reducers Desulfovibrio, Desulfomicrobium, and Desulfuromonas (95% relative abundance in total) were dominant. We also found evidence of enhanced mineral dissolution within the flow-through experiment, but there was little evidence of secondary deposits in the presence of biota. In contrast, SiO2 and Fe deposits formed within the batch experiment with biota but not under abiotic conditions. The results from these initial experiments indicate that different geochemical biosignatures can be generated between open and closed systems, and therefore, biosignature formation in open systems warrants further investigation.

Coherent Phase Change in Interstitial Solutions: A Hierarchy of Instabilities.

Metal hydrides or lithium ion battery electrodes can take the form of interstitial solid solutions with a miscibility gap. This work discusses theory approaches for locating, in temperature-composition space, coherent phase transformations during the charging/discharging of such systems and for identifying the associated transformation mechanisms. The focus is on the simplest scenario, where instabilities derive from the thermodynamics of the bulk phase alone, considering strain energy as the foremost consequence of coherency and admitting for stress relaxation at free surfaces. The extension of the approach to include capillarity is demonstrated by an example. The analysis rests on constrained equilibrium phase diagrams that are informed by geometry- and dimensionality-specific mechanical boundary conditions and on elastic instabilities-again geometry-specific-as implied by the theory of open-system elasticity. It is demonstrated that some scenarios afford the analysis of chemical stability to be based entirely on a linear stability analysis of the mechanical equilibrium, which provides closed-form solutions in a straightforward manner. Attention is on the impact of the system geometry (infinitely extended or of finite size) and on the chemical (closed or open system) and mechanical (incoherent or coherent) boundary conditions. Transformation mechanism maps are suggested for documenting the findings. The maps reveal a hierarchy of instabilities, which depend strongly on each of the above characteristics. Specifically, realistic, finite-sized systems differ qualitatively from idealized systems of infinite extension. Among the transformation mechanisms exposed by the analysis are a uniform switchover to the other phase when the open system reaches its chemical spinodal, practical coherent nucleation, as well as chemo-elastically coupled spontaneous buckling modes, which may take the form of either, single-phase or dual-phase states.

Open-system force-elongation relationship of collagen in chemo-mechanical equilibrium with water.

A significant deformation mechanism of collagen at low loads is molecular uncoiling and rearrangement. Although the effect of hydration and cross-linking has been investigated at larger loads when collagen undergoes molecular sliding, their effects on collagen molecular reorganization remain unclear. Here we develop two thermodynamic models that use the notion of open-system elasticity to elucidate the effect of swelling due to water uptake during deformation of collagen networks under low and high cross-linking conditions. With low crosslinking, entropic contributions dominate resulting in rejection of solvent from the polymer network leading to reduced collagen stiffness with increased loads. Contrarily, high cross-linking inhibits initial coiling and structural kinking and the mechanical behavior is dominated by elastic energy. In this configuration, the solvent content depends on the sign of the applied load resulting in a non-linear open-system stress-strain relationship. The models provide insight on the parameters that impact the stress-strain relationships of hydrated collagen and can inform the way collagenous matrices are treated both in medical and laboratory settings.

AgeSpectraAnalyst: A MATLAB based package to model zircon age distributions in silicic magmatic systems.

In the last decade, improvements in the analytical precision achievable by zircon U-Pb geochronological techniques have allowed to resolve complexities of zircon crystallization histories in magmatic rocks to an unprecedented level. A number of studies have strived to link resolvable dispersion in zircon age spectra of samples from fossil magmatic systems to the physical parameters of their parent magma bodies. However, the methodologies developed have so far been limited to reproduce the effect of simple thermal histories on the final distribution of zircon ages. In this work we take a more nuanced approach, fine-tuning a thermodynamics-based zircon saturation model to predict the relative distribution of zircon ages in samples from silicic magma reservoirs experiencing open-system processes (e.g. heat/mass addition, mechanical mixing). Employing the MATLAB package (AgeSpectraAnalyst) presented in this contribution:•Users can forward model the effect that diverse thermal histories and mechanical mixing processes characteristic of silicic magma bodies have on zircon age distributions as measured by high-precision, chemical abrasion thermal ionization mass spectrometry (CA-ID-TIMS) U-Pb geochronology.•Zircon CA-ID-TIMS datasets from silicic magmatic systems can be easily compared with model output to gain semi-quantitative information on thermo-mechanical history of the system of interest.•We demonstrated (Tavazzani et al., in press) that distribution of high-precision zircon ages in crystallized remnants of shallow (∼ 250 MPa), silicic magma reservoirs can discriminate between systems that experienced catastrophic, caldera-forming eruptions and systems that underwent monotonic cooling histories.

Evaluating Ecological Impact and Sustainability in the Manufacturing of Advanced Therapies: Comparative Analysis of Greenhouse Gas Emissions in the Production of ATMPs in Open and Closed Systems.

The primary aim of this systematic analysis is to highlight opportunities to improve the environmental impact of advanced therapy medicinal products (ATMP) manufacturing. We have compared the Greenhouse Gas (GHG) emissions expressed in CO2eq of a classic clean room open system (AinB) Cell Factory versus a comparable closed system equipped with isolators (AinD). We have therefore outlined a theoretical situation to simulate the use of a closed system with an equivalent production output to that obtained in the Cell Factory (CF) of the Regina Margherita Children's Hospital. Open and closed systems for ATMPs have been compared as regards energy requirements, ecological footprints, and costs by analyzing a hypothetic cell production cycle of 21 days. The results demonstrate energy saving and a reduction of 52% in GHG emissions using closed systems per process cycle. Moreover, a reduction in production costs in an isolator setting is also evident. This study shows that the closed system solution has evident advantages compared with the open one.

DNA droplets for intelligent and dynamical artificial cells: from the viewpoint of computation and non-equilibrium systems.

Living systems are molecular assemblies whose dynamics are maintained by non-equilibrium chemical reactions. To date, artificial cells have been studied from such physical and chemical viewpoints. This review briefly gives a perspective on using DNA droplets in constructing artificial cells. A DNA droplet is a coacervate composed of DNA nanostructures, a novel category of synthetic DNA self-assembled systems. The DNA droplets have programmability in physical properties based on DNA base sequence design. The aspect of DNA as an information molecule allows physical and chemical control of nanostructure formation, molecular assembly and molecular reactions through the design of DNA base pairing. As a result, the construction of artificial cells equipped with non-equilibrium behaviours such as dynamical motions, phase separations, molecular sensing and computation using chemical energy is becoming possible. This review mainly focuses on such dynamical DNA droplets for artificial cell research in terms of computation and non-equilibrium chemical reactions.

Keep It Simple: Improving the Ex Situ Culture of Cystoseira s.l. to Restore Macroalgal Forests.

Brown algae from genus Cystoseira s.l. form dense underwater forests that represent the most productive areas in the Mediterranean Sea. Due to the combined effects of global and local stressors such as climate change, urbanization, and herbivore outbreaks, there has been a severe decline in brown algal forests in the Mediterranean Sea. Natural recovery of depleted sites is unlikely due to the low dispersal capacity of these species, and efficient techniques to restore such habitats are needed. In this context, the aims of our study were (1) to improve and simplify the current ex situ laboratory protocol for the cultivation of Gongolaria barbata by testing the feasibility of some cost-effective and time-efficient techniques on two donor sites of G. barbata and (2) to evaluate the survival and growth of young thalli during the laboratory phase and during the most critical five months after out-planting. Specifically, the following ex situ cultivation methods were tested: (A) cultivation on clay tiles in mesocosms with culture water prepared by three different procedures (a) filtered seawater with a 0.22 µm filter membrane, (b) filtered seawater with a 0.7 µm filter membrane (GF), and (c) UV-sterilized water, and (B) cultivation on clay tiles in open laboratory systems. After two weeks, all thalli were fixed to plastic lantern net baskets suspended at a depth of 2 m in the coastal sea (hybrid method), and the algal success was monitored in relation to the different donor sites and cultivation protocol. The satisfactory results of this study indicate that UV-sterilized water is suitable for the cultivation of G. barbata in mesocosm, which significantly reduces the cost of the laboratory phase. This opens the possibility of numerous and frequent algal cultures during the reproductive period of the species. Additionally, if the young thalli remain in the lantern net baskets for an extended period of several months, they can grow significantly in the marine environment without being exposed to pressure from herbivorous fish.

"The trip actually opened our eyes to things that we were supposed to do and we were not doing": developing primary health care system leadership in a low-income country with peer exchanges.

BACKGROUND: Health care systems in low and middle-income countries are decentralizing and devolving power to the periphery. Transferring power without systematic processes to develop and nurture leaders at the district compromises the effectiveness and sustainability of the decentralized health system. To address this problem, we developed an approach to leadership learning by observation and experience that improved the organization and performance of the health care system in a district in Ghana. METHODOLOGY: Using two rounds of a longitudinal qualitative study, the study explores the determinants of implementing the Community-Based Health Planning and Services (CHPS) initiative in a district in Ghana. Insights were gained concerning the leadership regimes of two leaders who administered health services in a common geographic area at different points in time with remarkably contrasting outcomes. Insights of health workers who participated in both periods were elicited to clarify interview contexts. Ten focus group discussions (FGDs) and five expert interviews were conducted for each round of the study. The study was informed by a systems appraisal approach that utilized a thematic analytical framework. RESULTS: Providing district leaders with a practical observational experience had a significant influence on health care delivery in all aspects of health care provision at the district level. Exposing participants to models of best practices facilitated the replication of processes that improved the conduct of service delivery and CHPS implementation. Upon reflection, district leaders attributed performance constraints to their lack of understanding of practical ways of responding to complex district health system development needs. Observation from community members, volunteers, and health workers who witnessed the system development period corroborated narratives that leaders had expressed. CONCLUSION: Effective leadership is optimally developed with participatory learning that provides leaders with direct access to fully functioning systems. Learning by observation can be structured and used to quicken the spread of managerial excellence.

Digital Quantum Simulation of the Spin-Boson Model under Markovian Open-System Dynamics.

Digital quantum computers have the potential to simulate complex quantum systems. The spin-boson model is one of such systems, used in disparate physical domains. Importantly, in a number of setups, the spin-boson model is open, i.e., the system is in contact with an external environment which can, for instance, cause the decay of the spin state. Here, we study how to simulate such open quantum dynamics in a digital quantum computer, for which we use an IBM hardware. We consider in particular how accurate different implementations of the evolution result as a function of the level of noise in the hardware and of the parameters of the open dynamics. For the regimes studied, we show that the key aspect is to simulate the unitary portion of the dynamics, while the dissipative part can lead to a more noise-resistant simulation. We consider both a single spin coupled to a harmonic oscillator, and also two spins coupled to the oscillator. In the latter case, we show that it is possible to simulate the emergence of correlations between the spins via the oscillator.

Pesticide degradation in an integrated constructed wetland: Insights from compound-specific isotope analysis and 16S rDNA sequencing.

Carbon isotope analysis and the 16S rDNA sequencing were adopted to investigate the degradation process of chlorpyrifos during its transport in the integrated constructed wetland (ICW). Firstly, the extent of concentration decrease of chlorpyrifos was examined, and the removal efficiency in the first 36 h was found to be the highest. The removal rate reached 96.83 % after 96 h, and this process fit to the first-order kinetic model, with a kinetic constant (k) of 0.066 h-1. A significant carbon isotope fractionation was observed, with a change of the δ13C values from -26.54 ± 0.07 ‰ to -25.41 ± 0.08 ‰. The average chlorpyrifos biodegradation proportion reached 71.23 % (60.42 %-85.04 %), and it was predicted that about 11.79 %-36.41 % of chlorpyrifos removal in the ICW was attributed to abiotic factors. The outlet of the subsurface flow constructed wetland saw the highest D∗/B∗ value (1.38-3.88), indicating that the remaining fraction of dilution was much more significant than that of degradation in this period. The top 20 phyla of microbial community were identified in the ICW. Proteobacteria was the most dominant phylum, accounting for >40 % of the bacterial communities in all sampling locations. Acidobacteria and Bacteroidetes were the second and third dominant phyla. At the genus level, the microbial community composition differed more greatly in every stage of the ICW, and the spatial distribution difference was quite significant in the ICW. This study is important to figure out the migration and transformation of chlorpyrifos when the ICW was adopted as a removal tool for organic micro-pollutants, and more similar studies could be carried out in the future to promote the evaluation of pollutant removal capacity of the ICWs, and to further develop the application of stable isotope analysis of compounds in the natural environment.

ATP Recycling Fuels Sustainable Glycerol 3-Phosphate Formation in Synthetic Cells Fed by Dynamic Dialysis.

The bottom-up construction of an autonomously growing, self-reproducing cell represents a great challenge for synthetic biology. Synthetic cellular systems are envisioned as out-of-equilibrium enzymatic networks encompassed by a selectively open phospholipid bilayer allowing for protein-mediated communication; internal metabolite recycling is another key aspect of a sustainable metabolism. Importantly, gaining tight control over the external medium is essential to avoid thermodynamic equilibrium due to nutrient depletion or waste buildup in a closed compartment (e.g., a test tube). Implementing a sustainable strategy for phospholipid biosynthesis is key to expanding the cellular boundaries. However, phospholipid biosynthesis is currently limited by substrate availability, e.g., of glycerol 3-phosphate, the essential core of phospholipid headgroups. Here, we reconstitute an enzymatic network for sustainable glycerol 3-phosphate synthesis inside large unilamellar vesicles. We exploit the Escherichia coli glycerol kinase GlpK to synthesize glycerol 3-phosphate from externally supplied glycerol. We fuel phospholipid headgroup formation by sustainable l-arginine breakdown. In addition, we design and characterize a dynamic dialysis setup optimized for synthetic cells, which is used to control the external medium composition and to achieve sustainable glycerol 3-phosphate synthesis.

In situ off-line extracorporeal photopheresis conducted in a real-life situation at a Hemobiotherapy Department in France: A comparison of costs vs on-line procedure.

BACKGROUND: The off-line extracorporeal photopheresis (ECP) procedure requires photosensitization in an external cell therapy laboratory as per the French regulatory requirement. This regulation results in higher time and costs compared with the on-line alternative performed entirely at the patient's bedside. Recently, full in situ execution of the off-line procedure has been implemented in the Pitié-Salpêtrière Hospital Hemobiotherapy Department (Paris, France). This report summarizes the center's experience regarding the organizational and costs impacts of this change compared with the on-line procedure. MATERIAL AND METHODS: ECP was broken down into stages, and several procedures were monitored prospectively in real-life settings. The total costs associated with both procedures were the sum of the fixed costs and variable costs related to all stages of the procedures, nursing-time costs, property costs, and patient-related production loss costs. RESULTS: Eight off-line ECP and fourteen on-line ECP procedures were monitored during five consecutive days. Procedure duration was not different (median 137.5 vs 154.0 minutes, P = .29). Times and costs associated with nursing were higher but offset by lower fixed costs of the off-line ECP. Total direct costs per procedure associated with using the off-line ECP were significantly lower than those of the on-line procedure (459.6 ± 7.1 EUR vs 953.8 ± 6.5 EUR; P = .0002). Similar results were observed when including the costs of patient production loss. CONCLUSIONS: As a competitive time procedure, the in situ off-line method proved to be cost-efficient by effectively offering similar patient treatment per year compared with the on-line procedure.

Quantifying Decoherence via Increases in Classicality.

As a direct consequence of the interplay between the superposition principle of quantum mechanics and the dynamics of open systems, decoherence is a recurring theme in both foundational and experimental exploration of the quantum realm. Decoherence is intimately related to information leakage of open systems and is usually formulated in the setup of "system + environment" as information acquisition of the environment (observer) from the system. As such, it has been mainly characterized via correlations (e.g., quantum mutual information, discord, and entanglement). Decoherence combined with redundant proliferation of the system information to multiple fragments of environment yields the scenario of quantum Darwinism, which is now a widely recognized framework for addressing the quantum-to-classical transition: the emergence of the apparent classical reality from the enigmatic quantum substrate. Despite the half-century development of the notion of decoherence, there are still many aspects awaiting investigations. In this work, we introduce two quantifiers of classicality via the Jordan product and uncertainty, respectively, and then employ them to quantify decoherence from an information-theoretic perspective. As a comparison, we also study the influence of the system on the environment.

Application of Quantum-Markov Open System Models to Human Cognition and Decision.

Markov processes, such as random walk models, have been successfully used by cognitive and neural scientists to model human choice behavior and decision time for over 50 years. Recently, quantum walk models have been introduced as an alternative way to model the dynamics of human choice and confidence across time. Empirical evidence points to the need for both types of processes, and open system models provide a way to incorporate them both into a single process. However, some of the constraints required by open system models present challenges for achieving this goal. The purpose of this article is to address these challenges and formulate open system models that have good potential to make important advancements in cognitive science.

Shifting resource utilization of the lacustrine shrimp Palaemon paucidens in temperate coastal lagoons of Korea as revealed by stable isotopes.

The spatial and seasonal variations in resource use of the lacustrine shrimp Palaemon paucidens were investigated in three different Korean lagoon systems in June and October 2018 by measuring their carbon and nitrogen stable isotope ratios. P. paucidens had much higher δ13C values at the permanently open lagoon (PL) as compared to the intermittently open lagoons (ILs), revealing a disparity in resource utilization. Isotopic niches of the shrimp were relatively wider at the PL than at the ILs, suggesting a greater diversity of carbon pathways in the PL system. These results indicate that the degree of water exchange with the sea, associated with lagoon geomorphology, may be a major factor influencing resource availability for P. paucidens. Our findings suggest that the duration and degree of inlet opening may affect dietary variation at the population level, and may be one of the key components of sustainable management for coastal lagoon ecosystems.

Safety of Enteral Nutrition Practices: Overcoming the Contamination Challenges.

Enteral nutrition (EN) has host of benefits to offer to critically ill patients and is the preferred route of feeding over parenteral nutrition. But along with the many outcome benefits of enteral feeding come the potential for adverse effects that includes gastrointestinal (GI) disturbances mainly attributed to contaminated feeds. Currently, EN is practiced using blenderized/kitchen prepared feeds or scientifically developed commercial feeds. Commercial feeds based on their formulation may be divided as ready-to-mix powder formulas or ready-to-hang sterile liquid formulas. A holistic view on potential sterility of EN from preparation to patient delivery would be looked upon. These sterility issues may potentially result in clinical complications, and hence process-related errors need to be eliminated in hospital practice, since immunocompromised intensive care unit patients are at high risk of infection. This review intends to discuss the various EN practices, risk of contamination, and ways to overcome the same for better nutrition delivery to the patients. Among the various types of enteral formulas and delivery methods, this article tries to summarize several benefits and risks associated with each delivery system using the currently available literature. HOW TO CITE THIS ARTICLE: Sinha S, Lath G, Rao S. Safety of Enteral Nutrition Practices: Overcoming the Contamination Challenges. Indian J Crit Care Med 2020;24(8):709-712.

Increasing suction pressure during endotracheal suctioning increases the volume of suctioned secretions, but not procedure-related complications: A comparative study in open system endotracheal suctioning.

OBJECTIVES: To compare the effect of three different suction pressures (80 mmHg, 150 mmHg, 250 mmHg) with the open system suction method in terms of the volume of secretions and complications development in intubated intensive care patients. RESEARCH METHODOLOGY/DESIGN: This study was planned as a prospective, experimental, self-controlled design. The study sample included 47 patients. Data were collected using a data collection and patient follow-up form from patient records. SETTING: Single adult intensive care unit in a university hospital. RESULTS: Fifty five percent of the patients were male, 61.7% were older than 65 years and 38.32% had lung infection. The amount of suctioned secretions tended to increase significantly with increasing negative pressure and there was a significant difference between the pressures in terms of the median volume of suctioned secretions (p < 0.001). There was no significant difference between the suction pressures in terms of oxygen desaturation, hypertension rates (p > 0.05). Tachycardia, bradycardia, hypoxaemia, tracheal mucosal damage or mucosal bleeding were not observed during suctioning with three different suction pressures. CONCLUSION: It may be assumed that 250 mmHg suction pressure, via compliance with open system suction method related procedures, is being more effective and equally safe for secretion cleaning in comparison to the 80 and 150 mmHg suction pressures.