Subglottic Secretion Drainage for Preventing Ventilator-Associated Pneumonia: a Meta-Analysis

Dezfulian C, Shojania K, Collard H, et al. The American Journal of Medicine. 2005;118,11-18.

Objective

To assess the efficacy of subglottic secretion drainage in preventing ventilator-associated
pneumonia.

Methods

A meta-analysis combined and analyzed data from randomized trials comparing subglottic secretion drainage with standard endotracheal tube care in mechanically ventilated patients. Summary risk ratios or weighted mean differences with 95% confidence intervals were calculated for each outcome using a fixed-effects model.

Results

One hundred ten studies were retrieved, of which five studies met the inclusion criteria and
enrolled 896 patients.^1-5 Results are as follows:

• Subglottic secretion drainage reduced the incidence of ventilator-associated pneumonia by nearly half (risk ratio [RR] = 0.51; 95% confidence interval [CI]: 0.37 to 0.71).
• Subglottic secretion drainage reduced the incidence of pneumonia primarily by reducing early-onset pneumonia occurring within 5 to 7 days after intubation.
• Significant heterogeneity was found for several endpoints, but this was resolved by excluding a single outlying study, which primarily recruited patients ventilated <72 hours.
• In the remaining four studies that recruited patients expected to require >72 hours
  mechanical ventilation, subglottic secretion drainage was shown to:
  • Shorten duration of mechanical ventilation by 2 days
  • Decrease length of stay in the intensive care unit by 3 days
  • Delay onset of pneumonia by 6.8 days

Conclusion

"Subglottic secretion drainage appears effective in preventing early-onset ventilator-associated pneumonia among patients expected to require >72 hours of mechanical ventilation.”

References

1. Mahul Ph, Auboyer C, Jospe R, et al. Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Medicine. 1992;18:20-25.
2. Valles J, Artigas A, Rello J, et al. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Annals of Internal Medicine. 1995;122:179-186.
3. Kollef MH, Skubas NJ, Sundt TM. A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients. Chest. 1999;116:1339-1346.
4. Smulders K, van der Hoeven H, Weers-Pothoff I, Vandenbroucke-Grauls, C. A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Chest. 2002;121:858-862.
5. Bo H, He L, Qu J: Influence of the subglottic secretion drainage on the morbidity of ventilator-associated pneumonia in mechanically ventilated patients (in Chinese). Zhonghua Jie He He Hi Xi Za Zhi. 2000;23:472-474.

View more clinical studies