Comparison of subglottic vs. non-subglottic secretion drainage in prevention of Ventilator Associated Pneumonia: A systematic review and meta-analysis

Comparison of the Use of Conventional and Antibiotic-Coated Tracheal Tubes and EVAC on the Incidence of Ventilator-Associated Pneumonia (VAP)

“…However, long-term use of these tubes can lead to ventilator-associated pneumonia (VAP) [1]. VAP refers to pneumonia that occurs after 48 hours of intubation and mechanical ventilation of the patient and develops pneumonia [2]. VAP is the most common fatal infection among patients, treated in the intensive care unit [1].…”

“…The second most common hospital infection in acute patients is pneumonia, which affects 27% of critically ill patients [2].…”

Response to Society for Healthcare Epidemiology (SHEA) recommendations for ventilator-associated pneumonia (VAP)

“…1 However, 2 recent meta-analyses have demonstrated that use of endotracheal tubes (ETTs) with SSD reduced VAP rates by 44% 3-50%. 4 Further, routine use of SSD may reduce the risk of postoperative VAP in patients undergoing cardiac surgery, with those undergoing intraoperative continuous and postoperative intermittent SSD reporting a 70% reduction in the rate of postoperative VAP. 5 Although these findings are very promising, they were not considered when reclassifying SSD recommendations in the new guidelines.…”

“…6 Even so, a recent meta-analysis reported that SSD delayed time to VAP by 2.66-4.04 days. 4 In regard to cuff material, the new guidelines contend that ultrathin polyurethane cuffs are inconsistently associated with lower VAP rates and have no, or negative, impact on duration of mechanical ventilation, LOS, or mortality. 1 The main reference used to make this determination was a study that reported that polyurethane cuffs did not reduce bacterial colonization or VAP compared with cylindrical PVC cuffs.…”

“…This false sense that a quality measure has been optimized may prevent further efforts toward improvement. 4 Furthermore, some patients with chronic central lines, such as those on total parenteral nutrition for shortbowel syndrome, may have unmodifiable risk factors for recurrent bloodstream infections that will repeatedly contribute to CLABSI rates, even with aggressive prevention strategies. 5 As central-line care optimizes over time, more difficult-to-prevent CLABSIs, such as those identified with the dCLABSI and EOL-CLABSI subgroups, will start to overshadow pCLABSIs, making it increasingly difficult to demonstrate the importance of infection prevention or observe statistical differences when studying novel prevention techniques.…”