Continuous Versus Intermittent Subglottic Secretion Drainage to Prevent Ventilator-Associated Pneumonia: A Systematic Review

Abstract

Background Ventilator-associated pneumonia is associated with high morbidity and mortality in patients receiving mechanical ventilation. Subglottic secretion drainage, which may be performed continuously or intermittently, is believed to be an effective strategy for coping with ventilator-assisted pneumonia. Whether continuous or intermittent subglottic secretion drainage is superior for preventing ventilatorassisted pneumonia remains unknown. Methods This study is a comprehensive, systematic meta-analysis of randomized trials comparing continuous and intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Studies in English and Chinese published from January 1970 through November 2015 were identified by searching multiple databases. Summary risk ratios or weighted mean differences with 95% CIs were used to calculate each outcome by means of fixed-or random-effects models. Results Eight studies enrolling a total of 1071 patients met the inclusion criteria. The summary risk ratio between continuous and intermittent subglottic secretion drainage for incidence of ventilator-assisted pneumonia was 0.83 (95% CI, 0.61-1.13); for time to ventilator-assisted pneumonia occurrence, 2.73 (95% CI, -0.39 to 5.85); for occult blood, 2.34 (95% CI, 0.25-21.88); for duration of mechanical ventilation, -0.89 (95% CI, -2.72 to 0.94); for length of intensive care unit stay, 3.98 (95% CI, -4.44 to 12.41); and for mortality, 0.80 (95% CI, 0.48-1.31). Conclusions The results indicate no apparent differences between continuous and intermittent subglottic secretion drainage for the treatment outcomes included in the analysis. Rigorously designed, large-scale randomized controlled trials are warranted to identify the roles of continuous and intermittent subglottic secretion drainage. (Critical Care Nurse. 2017;37[5]:e10-e17)

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

“…Moreover, these VAP bundles and/or co-interventions were different in the included studies, potentially representing a source of heterogeneity. Sixth, although a subgroup analysis by SSD techniques could be feasible in this meta-analysis, it was disregarded because recent meta-analyses [25,62] did not report any differences between continuous and intermittent SSD to prevent VAP. Finally, due to the nature of the intervention, it could not be blinded for health staff, so only some RCTs were partially blinded.…”

The risk factors for the postoperative pulmonary infection in patients with hypertensive cerebral hemorrhage

“…These bacteria can migrate down the respiratory tract, increase the chance of pulmonary infections. Previous studies [ 43 , 44 ] have confirmed that the subglottic secretion drainage is beneficial to combating the pulmonary infection. Study [ 45 ] has shown that pulmonary infections are prone to occur after mechanical ventilation, mainly because the bacteria that adhere to the upper respiratory tract and it can be blown to the lower respiratory tract by tracheal tube.…”

Is continuous better than intermittent control of tracheal cuff pressure? A meta‐analysis

“…It has been reported that the entry of bacteria into the lower respiratory tract by microaspiration of contaminated oropharyngeal and gastric secretions may be accountable for the occurrence of VAP (Blot et al, 2014). Therefore, many interventions have been used to prevent this process, such as the subglottic secretion drainage (SSD) (Muscedere et al, 2011;Wen et al, 2017), the administration of probiotics (Siempos et al, 2010) and oral hygiene care (Hua et al, 2016).…”