Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis
Abstract
BACKGROUND AND PURPOSE: Aspiration of secretions containing bacterial pathogens into the lower respiratory tract is the main cause of ventilator-associated pneumonia. Endotracheal tubes with subglottic secretion drainage can potentially reduce this and, therefore, the incidence of ventilator-associated pneumonia. New evidence on subglottic secretion drainage as a preventive measure for ventilator-associated pneumonia has been recently published and to consider the evidence in totality, we conducted an updated systematic review and meta-analysis. DESIGN: We searched computerized databases, reference lists, and personal files. We included randomized clinical trials of mechanically ventilated patients comparing standard endotracheal tubes to those with subglottic secretion drainage and reporting on the occurrence of ventilator-associated pneumonia. Studies were meta-analyzed for the primary outcome of ventilator-associated pneumonia and secondary clinical outcomes. MEASUREMENTS AND MAIN RESULTS: We identified 13 randomized clinical trials that met the inclusion criteria with a total of 2442 randomized patients. Of the 13 studies, 12 reported a reduction in ventilator-associated pneumonia rates in the subglottic secretion drainage arm; in meta-analysis, the overall risk ratio for ventilator-associated pneumonia was 0.55 (95% confidence interval, 0.46-0.66; p < .00001) with no heterogeneity (I = 0%). The use of subglottic secretion drainage was associated with reduced intensive care unit length of stay (-1.52 days; 95% confidence interval, -2.94 to -0.11; p = .03); decreased duration of mechanically ventilated (-1.08 days; 95% confidence interval, -2.04 to -0.12; p = .03), and increased time to first episode of ventilator-associated pneumonia (2.66 days; 95% confidence interval, 1.06-4.26; p = .001). There was no effect on adverse events or on hospital or intensive care unit mortality. CONCLUSIONS: In those at risk for ventilator-associated pneumonia, the use of endotracheal tubes with subglottic secretion drainage is effective for the prevention of ventilator-associated pneumonia and may be associated with reduced duration of mechanical ventilation and intensive care unit length of stay.
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The predicted effect of ecological forces in the lungs of critically ill patients is a state of increased immigration, decreased elimination, and favourable growth conditions for potential pathogens.
“The predicted effect of these ecological forces in the lungs, therefore, is a state of increased immigration, decreased elimination, and favourable growth conditions for potential pathogens.”
From The microbiome and critical illness (2016) · cites this paper as [61]
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- Authors
- Muscedere, J., Rewa, O., Mckechnie, K., Jiang, X., Laporta, D., & Heyland, D. K.
- Affiliations
- Queen's University (CA)
- Venue
- Critical Care Medicine
- Published
- 2011-08
- Volume
- 39
- Issue
- 8
- Pages
- 1985-1991
- ISSN
- 0090-3493 (ISSN-L)
- OpenAlex
- W2013628062
- Cited by
- 311
- References
- 44
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 6 · 2023: 10 · 2022: 12 · 2021: 20 · 2020: 13 · 2019: 18 · 2018: 29 · 2017: 27 · 2016: 25 · 2015: 40 · 2014: 41 · 2013: 31 · 2012: 18
- FWCI
- 4.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Keywords
- subglottic secretion drainage, ventilator-associated pneumonia, endotracheal tube, mechanical ventilation, pneumonia prevention, ICU length of stay, mechanical ventilation duration, critically ill patients
- MeSH terms
- Critical Care, Female, Follow-Up Studies, Glottis, Humans, Intensive Care Units, Intubation, Intratracheal, Male, Respiration, Artificial, Suction, Survival Rate, Randomized Controlled Trials as Topic, Critical Illness, Treatment Outcome, Hospital Mortality, Risk Assessment, Pneumonia, Ventilator-Associated
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