BACKGROUND: Subglottic secretion drainage (SSD) has been shown to be associated with a lower incidence of ventilator-associated pneumonia (VAP) in a previous meta-analysis. However, a number of randomized controlled trials (RCTs) have been published since then, and so we aimed to conduct an updated meta-analysis. METHODS: A systematic literature search of Pubmed, Embase, and Cochrane Central Register of Controlled Trials was conducted using specific search terms. Eligible studies were RCTs that compared SSD with standard endotracheal tube care in mechanically ventilated adult patients. RESULTS: Ten RCTs with 2,213 patients were identified. SSD significantly reduced incidence of VAP (relative risk [RR] = 0.56, 95% confidence interval [CI]: 0.45-0.69, p < 0.00001) and early-onset VAP (RR = 0.23, 95% CI: 0.13-0.43, p < 0.00001), shortened ventilation duration by 1.55 days (95% CI: -2.40 to -0.71 days, p = 0.0003), and prolonged time to VAP by 3.90 days (95% CI: 2.56-5.24 days). Subgroup analyses suggested a significant reduction in incidence of VAP when stratified by intermittent (RR = 0.49, 95% CI: 0.34-0.71, p = 0.0001) and continuous SSD (RR = 0.61, 95% CI: 0.46-0.79, p = 0.0003). No significant differences were observed regarding incidence of late-onset VAP, overall mortality, or length of intensive care unit or hospital stay. CONCLUSIONS: This updated meta-analysis confirmed that SSD was beneficial in preventing VAP. Furthermore, the effect of SSD on late-onset VAP, comparison between intermittent and continuous SSD, and safety of SSD in mechanically ventilated patients should be evaluated in future RCTs. LEVEL OF EVIDENCE: I, meta-analysis.
BACKGROUND:Subglottic secretion drainage (SSD) has been shown to be associated with a lower incidence of ventilator-associated pneumonia (VAP) in a previous meta-analysis. However, a number of randomized controlled trials (RCTs) have been published since then, and so we aimed to conduct an updated meta-analysis. METHODS: A systematic literature search of Pubmed, Embase, and Cochrane Central Register of Controlled Trials was conducted using specific search terms. Eligible studies were RCTs that compared SSD with standard endotracheal tube care in mechanically ventilated adult patients. RESULTS: Ten RCTs with 2,213 patients were identified. SSD significantly reduced incidence of VAP (relative risk [RR] = 0.56, 95% confidence interval [CI]: 0.45-0.69, p < 0.00001) and early-onset VAP (RR = 0.23, 95% CI: 0.13-0.43, p < 0.00001), shortened ventilation duration by 1.55 days (95% CI: -2.40 to -0.71 days, p = 0.0003), and prolonged time to VAP by 3.90 days (95% CI: 2.56-5.24 days). Subgroup analyses suggested a significant reduction in incidence of VAP when stratified by intermittent (RR = 0.49, 95% CI: 0.34-0.71, p = 0.0001) and continuous SSD (RR = 0.61, 95% CI: 0.46-0.79, p = 0.0003). No significant differences were observed regarding incidence of late-onset VAP, overall mortality, or length of intensive care unit or hospital stay. CONCLUSIONS: This updated meta-analysis confirmed that SSD was beneficial in preventing VAP. Furthermore, the effect of SSD on late-onset VAP, comparison between intermittent and continuous SSD, and safety of SSD in mechanically ventilated patients should be evaluated in future RCTs. LEVEL OF EVIDENCE: I, meta-analysis.
Authors: Carmen Sílvia Valente Barbas; Alexandre Marini Isola; Augusto Manoel de Carvalho Farias; Alexandre Biasi Cavalcanti; Ana Maria Casati Gama; Antonio Carlos Magalhães Duarte; Arthur Vianna; Ary Serpa Neto; Bruno de Arruda Bravim; Bruno do Valle Pinheiro; Bruno Franco Mazza; Carlos Roberto Ribeiro de Carvalho; Carlos Toufen Júnior; Cid Marcos Nascimento David; Corine Taniguchi; Débora Dutra da Silveira Mazza; Desanka Dragosavac; Diogo Oliveira Toledo; Eduardo Leite Costa; Eliana Bernardete Caser; Eliezer Silva; Fabio Ferreira Amorim; Felipe Saddy; Filomena Regina Barbosa Gomes Galas; Gisele Sampaio Silva; Gustavo Faissol Janot de Matos; João Claudio Emmerich; Jorge Luis Dos Santos Valiatti; José Mario Meira Teles; Josué Almeida Victorino; Juliana Carvalho Ferreira; Luciana Passuello do Vale Prodomo; Ludhmila Abrahão Hajjar; Luiz Cláudio Martins; Luiz Marcelo Sá Malbouisson; Mara Ambrosina de Oliveira Vargas; Marco Antonio Soares Reis; Marcelo Brito Passos Amato; Marcelo Alcântara Holanda; Marcelo Park; Marcia Jacomelli; Marcos Tavares; Marta Cristina Paulette Damasceno; Murillo Santucci César Assunção; Moyzes Pinto Coelho Duarte Damasceno; Nazah Cherif Mohamad Youssef; Paulo José Zimmermann Teixeira; Pedro Caruso; Péricles Almeida Delfino Duarte; Octavio Messeder; Raquel Caserta Eid; Ricardo Goulart Rodrigues; Rodrigo Francisco de Jesus; Ronaldo Adib Kairalla; Sandra Justino; Sérgio Nogueira Nemer; Simone Barbosa Romero; Verônica Moreira Amado Journal: Rev Bras Ter Intensiva Date: 2014 Apr-Jun