Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis

Abstract

Although several guidelines recommend subglottic secretion drainage as a strategy for prevention of ventilator-associated pneumonia (VAP), its use is not widespread. With the aim to assess the effectiveness of subglottic secretion drainage for preventing VAP and to improve other outcomes such as mortality, duration of mechanical ventilation and length of stay in the intensive care unit (ICU) or hospital, an electronic search of the Cochrane Library, MEDLINE, Web of Science and Embase was undertaken. Nine systematic reviews with meta-analysis (in the overview of reviews) and 20 randomised controlled trials (in the updated meta-analysis) were included.In the overview of reviews, all systematic reviews with meta-analysis included found a positive effect of subglottic secretion drainage in the reduction of incidence of VAP. In the updated meta-analysis, subglottic secretion drainage significantly reduced VAP incidence (risk ratio (RR) 0.56, 95% CI 0.48–0.63; I2=0%, p=0.841) and mortality (RR 0.88, 95% CI 0.80–0.97; I2=0%, p=0.888).This is the first study that has found a decrease of mortality associated with the use of subglottic secretion drainage. In addition, subglottic secretion drainage is an effective measure to reduce VAP incidence, despite not improving the duration of mechanical ventilation and ICU and/or hospital length of stay.

Development and Validation of a Risk Prediction Model for Postoperative Pneumonia in Adult Patients Undergoing Stanford Type a Acute Aortic Dissection Surgery: A Case Control Study

“…Our prediction model may also play an important role in identifying and targeting high-risk patients for preventative measures. Several interventions have been shown to signi cantly reduce the incidence of POP, including subglottic secretion drainage [33], preoperative chlorhexidine mouthwash [34], and silvercoated endotracheal tubes [35]. Speci c interventions and appropriate preventative measures targeting high-risk patients identi ed by our prediction model may yield substantial clinical and economic bene ts.…”

Photoinactivation of Staphylococci with 405 nm Light in a Trachea Model with Saliva Substitute at 37 °C

“…While in our study visible light was added to achieve this, Hashemi et al [ 55 ] added an antimicrobial coating to an ETT. On the other hand there are also attempts to reduce the occurrence of VAP by changing the treatment of ventilated patients, like oral disinfection [ 56 , 57 ], subglottic drainage [ 58 , 59 , 60 ] and cuff pressure control [ 61 , 62 ].…”

Prävention der beatmungsassoziierten Pneumonie

“…Diese Technik war in ersten Untersuchungen effektiv und erfolgreich im Hinblick auf eine Reduktion vor allem der früh entstehenden VAP. Inzwischen liegt eine Metaanalyse der zahlreichen hierzu durchgeführten Studien vor, die erstmals nicht nur eine Reduktion der VAP-Inzidenz, sondern auch eine Reduktion der Letalität durch den Einsatz der subglottischen Sekretdrainage nahelegt [16].…”