Department of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
J Trauma Acute Care Surg. 2012 May;72(5):1276-85. doi: 10.1097/TA.0b013e318247cd33.
Subglottic secretion drainage (SSD) has been shown to be associated with a lower incidence of ventilator-associated pneumonia (VAP) in a previous meta-analysis. However, a number of randomized controlled trials (RCTs) have been published since then, and so we aimed to conduct an updated meta-analysis.
A systematic literature search of Pubmed, Embase, and Cochrane Central Register of Controlled Trials was conducted using specific search terms. Eligible studies were RCTs that compared SSD with standard endotracheal tube care in mechanically ventilated adult patients.
Ten RCTs with 2,213 patients were identified. SSD significantly reduced incidence of VAP (relative risk [RR] = 0.56, 95% confidence interval [CI]: 0.45-0.69, p < 0.00001) and early-onset VAP (RR = 0.23, 95% CI: 0.13-0.43, p < 0.00001), shortened ventilation duration by 1.55 days (95% CI: -2.40 to -0.71 days, p = 0.0003), and prolonged time to VAP by 3.90 days (95% CI: 2.56-5.24 days). Subgroup analyses suggested a significant reduction in incidence of VAP when stratified by intermittent (RR = 0.49, 95% CI: 0.34-0.71, p = 0.0001) and continuous SSD (RR = 0.61, 95% CI: 0.46-0.79, p = 0.0003). No significant differences were observed regarding incidence of late-onset VAP, overall mortality, or length of intensive care unit or hospital stay.
This updated meta-analysis confirmed that SSD was beneficial in preventing VAP. Furthermore, the effect of SSD on late-onset VAP, comparison between intermittent and continuous SSD, and safety of SSD in mechanically ventilated patients should be evaluated in future RCTs.
I, meta-analysis.
先前的荟萃分析表明，声门下分泌物引流（SSD）与呼吸机相关性肺炎（VAP）的发生率降低有关。然而，此后已有多项随机对照试验（RCT）发表，因此我们旨在进行更新的荟萃分析。
使用特定的搜索词，对 Pubmed、Embase 和 Cochrane 对照试验中心注册库进行了系统的文献检索。合格的研究是比较 SSD 与机械通气成人患者标准气管内管护理的 RCT。
确定了 10 项 RCT，共 2213 例患者。SSD 显著降低了 VAP 的发生率（相对风险 [RR] = 0.56，95%置信区间 [CI]：0.45-0.69，p < 0.00001）和早发性 VAP（RR = 0.23，95%CI：0.13-0.43，p < 0.00001），缩短了 1.55 天的通气时间（95%CI：-2.40 至 -0.71 天，p = 0.0003），并将 VAP 的发生时间延长了 3.90 天（95%CI：2.56-5.24 天）。亚组分析表明，当按间歇性（RR = 0.49，95%CI：0.34-0.71，p = 0.0001）和连续 SSD（RR = 0.61，95%CI：0.46-0.79，p = 0.0003）分层时，VAP 的发生率显著降低。关于晚发性 VAP、总死亡率或 ICU 或住院时间的长短，没有观察到显著差异。
本次更新的荟萃分析证实，SSD 有利于预防 VAP。此外，未来的 RCT 应评估 SSD 对晚发性 VAP 的影响、间歇性 SSD 与连续 SSD 之间的比较以及机械通气患者 SSD 的安全性。
I，荟萃分析。
