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Crit Care Med. 2016 Apr;44(4):830-40. doi: 10.1097/CCM.0000000000001414.

Subglottic Secretion Drainage and Objective Outcomes: A Systematic Review and Meta-Analysis.

Author information

1
1Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA. 2Department of Medicine, Brigham and Women's Hospital, Boston, MA. 3Department of Medicine, Critical Care Medicine Program, Queen's University, Kingston, ON, Canada.

Abstract

OBJECTIVE:

Current guidelines recommend endotracheal tubes with subglottic secretion drainage to prevent ventilator-associated pneumonia. Subglottic secretion drainage is associated with fewer ventilator-associated pneumonia diagnoses, but it is unclear to what extent this reflects fewer invasive pneumonias versus fewer false-positive diagnoses due to less secretions and/or less microbial colonization of the oropharynx. We, therefore, undertook a systematic review and meta-analysis of the impact of subglottic secretion drainage on duration of mechanical ventilation, ICU and hospital length of stay, ventilator-associated events, mortality, antibiotic utilization, stridor, and reintubations to better understand the net benefits and limitations of this intervention.

DATA SOURCES:

We searched Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica Database, and PubMed from inception through February 22, 2015, without language restrictions.

STUDY SELECTION:

Randomized controlled trials comparing subglottic secretion drainage versus no subglottic secretion drainage in adult patients on mechanical ventilation.

DATA EXTRACTION:

Eligible trials were abstracted and assessed for risk of bias by two reviewers.

DATA SYNTHESIS:

We identified 17 eligible trials with a total of 3,369 patients. Subglottic secretion drainage was associated with lower ventilator-associated pneumonia rates (risk ratio, 0.58; 95% CI, 0.51-0.67; I2 = 0%), but there were no significant differences between groups in duration of mechanical ventilation (weighted mean difference, -0.16 d; 95% CI, -0.64 to 0.33; I2 = 0%), ICU length of stay (weighted mean difference, +0.17 d; 95% CI, -0.62 to 0.95; I2 = 0%), hospital length of stay (weighted mean difference, -0.57 d; 95% CI, -2.44 to 1.30; I2 = 0%), ventilator-associated events (risk ratio, 0.97; 95% CI, 0.65-1.43), or mortality (risk ratio, 0.93; 95% CI, 0.84-1.03; I2 = 0%). Two studies observed significantly less antibiotic use with subglottic secretion drainage whereas a third did not. There were no significant differences between groups in stridor or reintubations.

CONCLUSIONS:

Subglottic secretion drainage is associated with lower ventilator-associated pneumonia rates but does not clearly decrease duration of mechanical ventilation, length of stay, ventilator-associated events, mortality, or antibiotic usage. Further data are required to demonstrate the benefits of subglottic secretion drainage.

PMID:
26646454
DOI:
10.1097/CCM.0000000000001414
[Indexed for MEDLINE]

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