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Objective: A closed suction system (CS) maintains connection with the mechanical ventilator during tracheal suctioning and is claimed to limit loss in lung volume and oxygenation. We compared changes in lung volume, oxygenation, airway pressure and hemodynamics during endotracheal suctioning performed with CS and with an open suction system (OS). Design: Prospective, randomized study. Setting: Intensive care unit in a university hospital. Patients: We enrolled ten patients, volume-controlled (VC) ventilated with a Siemens Servo 900 ventilator (PaO₂/FIO₂ 192±70, PEEP 10.7±3.9 cmH₂O). Interventions: We performed four consecutive tracheal suction maneuvers, two with CS and two with OS, at 20-min intervals. During the suction maneuvers continuous suction was applied for 20 s. Measurements and main results: We measured end-expiratory lung volume changes (ΔVL), tidal volume …