The online version of this article (doi:10.1186/s13054-016-1527-7) contains supplementary material, which is available to authorized users.
Potential benefits of subglottic secretion suction for preventing ventilator-associated pneumonia (VAP) are not fully understood.
We searched Cochrane Central, PubMed, and EMBASE up to March 2016 to identify randomized controlled trials (RCTs) that compared subglottic secretion suction versus non-subglottic secretion suction in adults with mechanical ventilation. Meta-analysis was conducted using Revman 5.3, trial sequential analysis (TSA) 0.9 and STATA 12.0. The primary outcome was incidence of VAP. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the level of evidence.
Twenty RCTs (N = 3544) were identified. Subglottic secretion suction was associated with reduction of VAP incidence in four high quality trials (relative risk (RR) 0.54, 95 % confidence interval (CI) 0.40–0.74; p < 0.00001) and in all trials (RR = 0.55, 95 % CI 0.48– 0.63; p < 0.00001). Sensitivity analyses did not show differences in the pooled results. Additionally, the results of the above-mentioned analyses were confirmed in TSA. GRADE level was high. Subglottic secretion suction significantly reduced incidence of early onset VAP, gram-positive or gram-negative bacteria causing VAP, and duration of mechanical ventilation. It delayed the time-to-onset of VAP. However, no significant differences in late onset VAP, intensive care unit (ICU) mortality, hospital mortality, or ICU length of stay were found.
Subglottic secretion suction decreased VAP incidence and duration of mechanical ventilation and delayed VAP onset. However, subglottic secretion suction did not reduce mortality and length of ICU stay. Subglottic secretion suction is recommended for preventing VAP and for reducing ventilation length, especially in the population at high risk of early onset VAP.
A protocol of this meta-analysis has been registered on PROSPERO (registration number: CRD42015015715); registered on 5 January 2015.
Additional file 1: Table S1. The secondary outcomes with VAP invasive diagnosis. (DOC 56 kb)13054_2016_1527_MOESM1_ESM.doc
Additional file 2: Figure S1. Funnel plot to evaluate potential publication bias for incidence of ventilator-associated pneumonia including all trials. RR relative risk, SE standard error. (TIF 790 kb)13054_2016_1527_MOESM2_ESM.tif
Additional file 3: Table S2. Comparison with previous meta-analyses. (DOCX 16 kb)13054_2016_1527_MOESM3_ESM.docx
Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R, Cdc, Healthcare Infection Control Practices Advisory C. Guidelines for preventing healthcare-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004;53(RR-3):1–36. PubMed
Alvarez Lerma F, Sanchez Garcia M, Lorente L, Gordo F, Anon JM, Alvarez J, Palomar M, Garcia R, Arias S, Vazquez-Calatayud M, et al. Guidelines for the prevention of ventilator-associated pneumonia and their implementation. The Spanish "Zero-VAP" bundle. Med Intensiva. 2014;38(4):226–36. PubMedCrossRef
Caroff DA, Li L, Muscedere J, Klompas M. Subglottic secretion drainage and objective outcomes: a systematic review and meta-analysis. Crit Care Med. 2016;44(4):830–40. PubMed
Damas P, Frippiat F, Ancion A, Canivet JL, Lambermont B, Layios N, Massion P, Morimont P, Nys M, Piret S, et al. Prevention of ventilator-associated pneumonia and ventilator-associated conditions: a randomized controlled trial with subglottic secretion suctioning. Crit Care Med. 2015;43(1):22–30. PubMedCrossRef
Gopal S, Luckraz H, Giri R, Nevill A, Muhammed I, Reid M, Bickerton S, Jenkins D. Significant reduction in ventilator-associated pneumonia with the Venner-PneuX System in high-risk patients undergoing cardiac surgery: the Low Ventilator-Associated-Pneumonia study. Eur J Cardiothorac Surg. 2015;47(3):e92–96. PubMedCrossRef
Tao Z, Zhao S, Yang G, Wang L, Zhu S. Effect of two methods of subglottic secretion drainage on the incidence of ventilator-associated pneumonia. Zhonghua Jie He He Hu Xi Za Zhi. 2014;37(4):283–6. PubMed
Koker A, Gok F, Erayman I, Yosunkaya A. Effect of subglottic secretion drainage for preventing ventilator-associated pneumonia. Crit Care. 2014;18:S119–20. CrossRef
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. The Cochrane Collaboration. 2011. [Updated March 2011]. Available from http://handbook.cochrane.org/.
Xia Y, Luo H, Liu JP, Gluud C. Phyllanthus species versus antiviral drugs for chronic hepatitis B virus infection. Cochrane Database Syst Rev. 2013;4:Cd009004.
Bo H, He L, Qu J. Influence of the subglottic secretion drainage on the morbidity of ventilator associated pneumonia in mechanically ventilated patients. Zhonghua Jie He He Hu Xi Za Zhi. 2000;23(8):472–4. PubMed
Liu QH, He LX, Hu BJ, Li HY, Chen XH, Gao XD, Chu DM, Zhu HL. Comprehensive prevention and pathogenesis of ventilator-associated pneumonia in elderly patients: a prospective, randomized, case-control clinical trial. Zhonghua Nei Ke Za Zhi. 2006;45(9):717–20. PubMed
Liu SH, Yan XX, Cao SQ, An SC, Zhang LJ. The effect of subglottic secretion drainage on prevention of ventilator-associated lower airway infection. Zhonghua Jie He He Hu Xi Za Zhi. 2006;29(1):19–22. PubMed
Yang CS, Qiu HB, Zhu YP, Huang YZ, Xu XT, Gao L. Effect of continuous aspiration of subglottic secretions on the prevention of ventilator-associated pneumonia in mechanically ventilated patients: a prospective, randomized, controlled clinical trial. Zhonghua Nei Ke Za Zhi. 2008;47(8):625–9. PubMed
Zheng RQ, Lin H, Shao J, Chen QH, Lu NF, Yu JQ. A clinical study of subglottic secretion drainage for prevention of ventilation associated pneumonia. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2008;20(6):338–40. PubMed
Seyfi S, Latifi S, Shirkhani Z. Effect of subglottic secretion drainage on the ventilator-associated pneumonia in ICU patients. J Babol Univ Med Sci. 2013;15(1):58–62.
Speroni KG, Lucas J, Dugan L, O'Meara-Lett M, Putman M, Daniel M, Atherton M. Comparative effectiveness of standard endotracheal tubes vs. endotracheal tubes with continuous subglottic suctioning on ventilator-associated pneumonia rates. Nurs Econ. 2011;29(1):15–20. 37. PubMed
- Subglottic secretion suction for preventing ventilator-associated pneumonia: an updated meta-analysis and trial sequential analysis
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II