Continuous control of tracheal cuff pressure for VAP prevention: a collaborative meta-analysis of individual participant data

BACKGROUND: Underinflation of tracheal cuff is a risk factor for microaspiration of contaminated secretions and subsequent ventilator-associated pneumonia (VAP). The aim of this collaborative meta-analysis of individual participant data is to determine the impact of continuous control of P(cuff) on the incidence of VAP. METHODS: Studies were identified by searching PubMed and references of relevant articles. Data from 3 prospective controlled trials (two randomized and one quasi-randomized), which evaluated the impact of continuous control of P(cuff) on the incidence of VAP, were obtained and pooled together. Three different devices were used to continuously control P(cuff). VAP was diagnosed using clinical, radiologic, and quantitative microbiological criteria. The impact of continuous control of P(cuff) on VAP was assessed by Cox regression analysis, stratified on trial. RESULTS: 263 (48.4 %) patients received continuous control of P(cuff), and 280 (51.5 %) patients received routine control of P(cuff) using a manometer. 36 (13.6 %) VAP were diagnosed in continuous control group, and 72 (25.7 %) in routine care group (HR 0.47, 95 % CI 0.31–0.71, p < 0.001). However, heterogeneity was apparent in continuous control effect size across trials (I(2) = 58 %, p = 0.085). The number of patients needed to treat to prevent one VAP episode was 8. No significant impact of continuous control of P(cuff) was found on duration of mechanical ventilation, ICU length of stay, or mortality. CONCLUSION: Continuous control of P(cuff) might be beneficial in reducing the risk for VAP. However, no significant impact of continuous control of P(cuff) was found on duration of mechanical ventilation, ICU length of stay, or mortality.