Abstract:Subglottic secretion suctioning resulted in a significant reduction of ventilator-associated pneumonia prevalence associated with a significant decrease in antibiotic use. By contrast, ventilator-associated condition occurrence did not differ between groups and appeared more related to other medical features than ventilator-associated pneumonia.
“…Twenty studies reported that 3544 patients were included in this meta-analysis (Fig. 1) [17, 20–24, 30–43]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Previous meta-analyses reported that SSS was associated with a lower rate of VAP [11–16]. However, many ICUs did not use SSS as a part of the VAP bundle [17]. Although about 55 % of hospitals in the US routinely used SSS in 2013 [18], European consensus did not recommend SSS for VAP prevention [19].…”
Section: Introductionmentioning
confidence: 99%
“…The need for future randomized controlled trials (RCTs) is still advocated [15, 16]. Six RCTs [17, 20–24] involving new evidence on this topic have been published recently.…”
BackgroundPotential benefits of subglottic secretion suction for preventing ventilator-associated pneumonia (VAP) are not fully understood.MethodsWe searched Cochrane Central, PubMed, and EMBASE up to March 2016 to identify randomized controlled trials (RCTs) that compared subglottic secretion suction versus non-subglottic secretion suction in adults with mechanical ventilation. Meta-analysis was conducted using Revman 5.3, trial sequential analysis (TSA) 0.9 and STATA 12.0. The primary outcome was incidence of VAP. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the level of evidence.ResultsTwenty RCTs (N = 3544) were identified. Subglottic secretion suction was associated with reduction of VAP incidence in four high quality trials (relative risk (RR) 0.54, 95 % confidence interval (CI) 0.40–0.74; p < 0.00001) and in all trials (RR = 0.55, 95 % CI 0.48– 0.63; p < 0.00001). Sensitivity analyses did not show differences in the pooled results. Additionally, the results of the above-mentioned analyses were confirmed in TSA. GRADE level was high. Subglottic secretion suction significantly reduced incidence of early onset VAP, gram-positive or gram-negative bacteria causing VAP, and duration of mechanical ventilation. It delayed the time-to-onset of VAP. However, no significant differences in late onset VAP, intensive care unit (ICU) mortality, hospital mortality, or ICU length of stay were found.ConclusionsSubglottic secretion suction decreased VAP incidence and duration of mechanical ventilation and delayed VAP onset. However, subglottic secretion suction did not reduce mortality and length of ICU stay. Subglottic secretion suction is recommended for preventing VAP and for reducing ventilation length, especially in the population at high risk of early onset VAP.Trial registrationA protocol of this meta-analysis has been registered on PROSPERO (registration number: CRD42015015715); registered on 5 January 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1527-7) contains supplementary material, which is available to authorized users.
“…Twenty studies reported that 3544 patients were included in this meta-analysis (Fig. 1) [17, 20–24, 30–43]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Previous meta-analyses reported that SSS was associated with a lower rate of VAP [11–16]. However, many ICUs did not use SSS as a part of the VAP bundle [17]. Although about 55 % of hospitals in the US routinely used SSS in 2013 [18], European consensus did not recommend SSS for VAP prevention [19].…”
Section: Introductionmentioning
confidence: 99%
“…The need for future randomized controlled trials (RCTs) is still advocated [15, 16]. Six RCTs [17, 20–24] involving new evidence on this topic have been published recently.…”
BackgroundPotential benefits of subglottic secretion suction for preventing ventilator-associated pneumonia (VAP) are not fully understood.MethodsWe searched Cochrane Central, PubMed, and EMBASE up to March 2016 to identify randomized controlled trials (RCTs) that compared subglottic secretion suction versus non-subglottic secretion suction in adults with mechanical ventilation. Meta-analysis was conducted using Revman 5.3, trial sequential analysis (TSA) 0.9 and STATA 12.0. The primary outcome was incidence of VAP. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the level of evidence.ResultsTwenty RCTs (N = 3544) were identified. Subglottic secretion suction was associated with reduction of VAP incidence in four high quality trials (relative risk (RR) 0.54, 95 % confidence interval (CI) 0.40–0.74; p < 0.00001) and in all trials (RR = 0.55, 95 % CI 0.48– 0.63; p < 0.00001). Sensitivity analyses did not show differences in the pooled results. Additionally, the results of the above-mentioned analyses were confirmed in TSA. GRADE level was high. Subglottic secretion suction significantly reduced incidence of early onset VAP, gram-positive or gram-negative bacteria causing VAP, and duration of mechanical ventilation. It delayed the time-to-onset of VAP. However, no significant differences in late onset VAP, intensive care unit (ICU) mortality, hospital mortality, or ICU length of stay were found.ConclusionsSubglottic secretion suction decreased VAP incidence and duration of mechanical ventilation and delayed VAP onset. However, subglottic secretion suction did not reduce mortality and length of ICU stay. Subglottic secretion suction is recommended for preventing VAP and for reducing ventilation length, especially in the population at high risk of early onset VAP.Trial registrationA protocol of this meta-analysis has been registered on PROSPERO (registration number: CRD42015015715); registered on 5 January 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1527-7) contains supplementary material, which is available to authorized users.
“…[17]. Moreover, during the last period of the study (starting in 2012), due to their proven efficacy in reducing VAP, we used endotracheal tubes with subglottic secretion suctioning in comatose patients admitted to the ICU [45]. This change in protocol could have biased our results by modifying the incidence of pneumonia during the study period.…”
EOVAP is frequent after a severe TBI (overall rate: 61%), with therapeutic hypothermia, severe thoracic lesion, and gastric aspiration as main risk factors. EOVAP had a negative impact on cerebral oxygenation measured by PbtO and was independently associated with unfavorable outcome at 1-year follow-up. This suggests that all precautions available should be taken to prevent EOVAP in this population.
“…Previous studies involving primarily medical patients, including multiple randomized controlled trials, have shown significant reduction in VAP rates in patients intubated with endotracheal tubes with subglottic secretion drainage (ETT-SSD). [10][11][12][13][14][15] Despite these purported benefits, these tubes are not widely used and have not been studied in traumatically injured patients; therefore, applicability to the traumatically injured population is unknown. We hypothesized that the use of ETT-SSD would reduce VAP in trauma patients, who are inherently high risk for VAP.…”
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