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Review
. 2020 Feb 12;29(155):190107.
doi: 10.1183/16000617.0107-2019. Print 2020 Mar 31.

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

Diana P Pozuelo-Carrascosa  1   2 , Ángel Herráiz-Adillo  3 , Celia Alvarez-Bueno  1 , Jose Manuel Añón  4 , Vicente Martínez-Vizcaíno  1   5 , Iván Cavero-Redondo  1
Affiliations
Review

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

Diana P Pozuelo-Carrascosa et al. Eur Respir Rev. .

Erratum in

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.

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Conflict of interest statement

Conflict of interest: D.P Pozuelo-Carracosa has nothing to disclose. Conflict of interest: A. Herráiz-Adillo has nothing to disclose. Conflict of interest: C. Alvarez-Bueno has nothing to disclose. Conflict of interest: J.M. Añón has nothing to disclose. Conflict of interest: V. Martínez-Vizcaíno has nothing to disclose. Conflict of interest: I. Cavero-Redondo has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Literature search: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram. SRMA: systematic reviews with meta-analysis; RCT: randomised controlled trial; SSD: subglottic secretion drainage.
FIGURE 2
FIGURE 2
Forest plot comparing subglottic secretion drainage (SSD) versus non-SSD on the incidence of ventilator-associated pneumonia (VAP). RR: risk ratio.
FIGURE 3
FIGURE 3
Forest plot comparing subglottic secretion drainage (SSD) versus non-SSD on mortality. RR: risk ratio; ICU: intensive care unit.
See this image and copyright information in PMC

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