Subglottic Secretion Drainage to Prevent Ventilator-Associated Pneumonia in Mechanically Ventilated Adult Patients: A Systematic Review and Meta-Analysis

Abstract

Background: Patients requiring invasive mechanical ventilation in the intensive care unit (ICU) are at risk for ventilator-associated pneumonia (VAP). Objectives: To summarize the results of published, randomized, clinical trials (RCTs), a meta-analysis was performed to examine the effect of subglottic secretion drainage (SSD) on the prevalence and outcomes of VAP in adult patients undergoing mechanical ventilation. Methods: A comprehensive search based on specific terms was performed as a systematic review and meta-analysis by a computerized database search in the national and international databases including MagIran, SID, Scopus, PubMed, ISI Web of Knowledge, ScienceDirect, Google Scholar, Cochrane Central, and IRCT as well as references from 1990 to 2018 in English and Persian languages. RCTs of SSD were considered as common care of adult patients undergoing mechanical ventilation in the current meta-analysis. Data analysis was carried out through the random and fixed effects model, and the heterogeneity was investigated by I2 and Q-Cochrane index. The data were analyzed using STATA 11. Results: A total of 24 eligible RCTs with 2434 patients were identified. The overall risk ratio for VAP was 14.7 (95% confidence interval (CI): 11.1 - 18.4); mortality 25.8 (95% CI: 17.3 - 34.3); length of ICU stay 13.4 (95% CI: 7.8 - 18.9) and hospital stay 23.2 (95% CI: 12.5 - 33.9); ventilation days 14.9 (95% CI: 7.3 - 22.6); airway secretion 10.2 (95% CI: 4.9 - 15.5); and APACHEII 19.5 (95% CI: 14.6 - 24.3). Conclusions: SSD is recommended to prevent VAP, and reduce mortality rate and the ICU LOS, especially in the high-risk patients undergoing mechanical ventilation for a long period of time.