Subglottic secretion drainage for preventing ventilator associated pneumonia: A meta-analysis

Abstract

Objective Ventilator associated pneumonia (VAP) has been shown to be associated with significant morbidity and mortality (Chastre and Fagon, 2002; Klompas, 2007) among mechanically ventilated patients in the intensive care unit (ICU), with the incidence ranging from 9% to 27%; crude mortality ranges from 25% to 50% (Rello, Ollendorf, Oster, et al., 2002; Tablan, Anderson, Besser, Bridges, Hajjeh, 2003). A meta-analysis of published studies was undertaken to combine information regarding the effect of subglottic secretion drainage (SSD) on the incidence of ventilated associated pneumonia in adult ICU patients. Methods Reports of studies on SSD were identified by searching the PUBMED, EMBASE, and COCHRANCE LIBRARY databases (December 30, 2010). Randomized trials of SSD compared to usual care in adult mechanically ventilated ICU patients were included in this meta-analysis. Results Ten RCTs with 2314 patients were identified. SSD significantly reduced the incidence of VAP (relative risk [RR] = 0.52, 95% confidence interval [CI]: 0.42–0.64, p < 0.00001). When SSD was compared with the control groups, the overall RR for ICU mortality was 1.00 (95% CI, 0.84–1.19) and for hospital mortality was 0.95 (95% CI, 0.80–1.13). Overall, the subglottic drainage effect on the days of mechanical ventilation was −1.52 days (95% CI, −2.94 to −0.11) and on the ICU length of stay (LOS) was −0.81days (95% CI, −2.33 to –0.7). Conclusions In this meta-analysis, when an endotracheal tube (ETT) with SSD was compared with an ETT without SSD, there was a highly significant reduction in the VAP rate of approximately 50%. Time on mechanical ventilation (MV) and the ICU LOS may be reduced, but no reduction in ICU or hospital mortality has been observed in published trials.