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The suction catheter can be introduced by disconnecting the patient from the ventilator (open suction system) or by introducing the catheter into the ventilatory circuit (closed suction system). Several studies have revealed that clinicians cannot suction all available secretion in the trachea and perform more frequent suctioning with a closed suctioning system (css) than with an open suctioning system (oss). Although the closed suctioning system (css) does not require practitioners to disconnect the patient from the ventilator, its efficacy as a standardized procedure has yet to be determined. Two primary methods are employed for endotracheal suctioning The open suction system (oss) and the closed suction system (css) Understanding the differences between these techniques is essential for optimizing patient outcomes and ensuring safety. This study aimed to explore the evidence surrounding the two different methods for tracheal aspiration to determine if css has better results than oss in adult patients connected to mv, due to it is not yet as explored field. There are two different methods to perform the suctioning procedure One is the more commonly used open suction system (oss), and the other is the closed suction system (css). Endotracheal suctioning (ets) is an essential procedure performed for mechanically ventilated patients Ets can be either performed by open or closed suctioning system (css) Open suctioning involves disconnecting the patient's artificial airway (such as an endotracheal tube or tracheostomy) from the ventilator during the suctioning process A suction catheter is then inserted into the airway to remove secretions A closed suction catheter system is designed to allow suctioning of airway secretions while the patient remains connected to the ventilator