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Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis

Although several guidelines recommend subglottic secretion drainage as a strategy for prevention of ventilator-associated pneumonia (VAP), its use is not widespread. With the aim to assess the effectiveness of subglottic secretion drainage for preventing VAP and to improve other outcomes such as mor...

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Autores principales: Pozuelo-Carrascosa, Diana P., Herráiz-Adillo, Ángel, Alvarez-Bueno, Celia, Añón, Jose Manuel, Martínez-Vizcaíno, Vicente, Cavero-Redondo, Iván
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Respiratory Society 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9488747/
https://www.ncbi.nlm.nih.gov/pubmed/32051169
http://dx.doi.org/10.1183/16000617.0107-2019
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author Pozuelo-Carrascosa, Diana P.
Herráiz-Adillo, Ángel
Alvarez-Bueno, Celia
Añón, Jose Manuel
Martínez-Vizcaíno, Vicente
Cavero-Redondo, Iván
author_facet Pozuelo-Carrascosa, Diana P.
Herráiz-Adillo, Ángel
Alvarez-Bueno, Celia
Añón, Jose Manuel
Martínez-Vizcaíno, Vicente
Cavero-Redondo, Iván
author_sort Pozuelo-Carrascosa, Diana P.
collection PubMed
description Although several guidelines recommend subglottic secretion drainage as a strategy for prevention of ventilator-associated pneumonia (VAP), its use is not widespread. With the aim to assess the effectiveness of subglottic secretion drainage for preventing VAP and to improve other outcomes such as mortality, duration of mechanical ventilation and length of stay in the intensive care unit (ICU) or hospital, an electronic search of the Cochrane Library, MEDLINE, Web of Science and Embase was undertaken. Nine systematic reviews with meta-analysis (in the overview of reviews) and 20 randomised controlled trials (in the updated meta-analysis) were included. In the overview of reviews, all systematic reviews with meta-analysis included found a positive effect of subglottic secretion drainage in the reduction of incidence of VAP. In the updated meta-analysis, subglottic secretion drainage significantly reduced VAP incidence (risk ratio (RR) 0.56, 95% CI 0.48–0.63; I(2)=0%, p=0.841) and mortality (RR 0.88, 95% CI 0.80–0.97; I(2)=0%, p=0.888). This is the first study that has found a decrease of mortality associated with the use of subglottic secretion drainage. In addition, subglottic secretion drainage is an effective measure to reduce VAP incidence, despite not improving the duration of mechanical ventilation and ICU and/or hospital length of stay.
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spelling pubmed-94887472022-11-14 Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis Pozuelo-Carrascosa, Diana P. Herráiz-Adillo, Ángel Alvarez-Bueno, Celia Añón, Jose Manuel Martínez-Vizcaíno, Vicente Cavero-Redondo, Iván Eur Respir Rev Review Although several guidelines recommend subglottic secretion drainage as a strategy for prevention of ventilator-associated pneumonia (VAP), its use is not widespread. With the aim to assess the effectiveness of subglottic secretion drainage for preventing VAP and to improve other outcomes such as mortality, duration of mechanical ventilation and length of stay in the intensive care unit (ICU) or hospital, an electronic search of the Cochrane Library, MEDLINE, Web of Science and Embase was undertaken. Nine systematic reviews with meta-analysis (in the overview of reviews) and 20 randomised controlled trials (in the updated meta-analysis) were included. In the overview of reviews, all systematic reviews with meta-analysis included found a positive effect of subglottic secretion drainage in the reduction of incidence of VAP. In the updated meta-analysis, subglottic secretion drainage significantly reduced VAP incidence (risk ratio (RR) 0.56, 95% CI 0.48–0.63; I(2)=0%, p=0.841) and mortality (RR 0.88, 95% CI 0.80–0.97; I(2)=0%, p=0.888). This is the first study that has found a decrease of mortality associated with the use of subglottic secretion drainage. In addition, subglottic secretion drainage is an effective measure to reduce VAP incidence, despite not improving the duration of mechanical ventilation and ICU and/or hospital length of stay. European Respiratory Society 2020-02-12 /pmc/articles/PMC9488747/ /pubmed/32051169 http://dx.doi.org/10.1183/16000617.0107-2019 Text en Copyright ©ERS 2020. https://creativecommons.org/licenses/by-nc/4.0/This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.
spellingShingle Review
Pozuelo-Carrascosa, Diana P.
Herráiz-Adillo, Ángel
Alvarez-Bueno, Celia
Añón, Jose Manuel
Martínez-Vizcaíno, Vicente
Cavero-Redondo, Iván
Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis
title Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis
title_full Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis
title_fullStr Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis
title_full_unstemmed Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis
title_short Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis
title_sort subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9488747/
https://www.ncbi.nlm.nih.gov/pubmed/32051169
http://dx.doi.org/10.1183/16000617.0107-2019
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