Subglottic secretion drainage for preventing ventilator-associated pneumonia: An updated meta-analysis of randomized controlled trials
Subglottic secretion drainage for preventing ventilator-associated pneumonia: An updated meta-analysis of randomized controlled trials
复制标题
声门下分泌物引流预防呼吸机相关性肺炎：随机对照试验的最新荟萃分析
DOI：
10.1097/ta.0b013e318247cd33
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发表时间：
2012-05-01
影响因子：
3.4
通讯作者：
Deng, Xiaoming
中科院分区：
文献类型：
--
作者：
Wang, Fei;Bo, Lulong;Deng, Xiaoming
背景技术背景：先前的荟萃分析显示声门下分泌物引流（SSD）与呼吸机相关性肺炎（VAP）的发生率较低相关。然而，一些随机对照试验（RCTs）已经出版，从那时起，所以我们的目的是进行更新的荟萃analysis.METHODS：Pubmed，Embase，和科克伦对照试验中心注册系统的文献检索进行了使用特定的检索词。符合条件的研究是随机对照试验，比较SSD与标准气管插管护理在机械通气的成人patients.Results：10项随机对照试验，2,213例患者被确定。SSD显著降低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），缩短通气时间1.55天（95% CI：-2.40至-0.71天，p = 0.0003），至VAP的时间延长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。迟发性VAP的发病率，总死亡率，或重症监护室或住院时间的长短没有显着差异观察。结论：这个更新的荟萃分析证实，SSD是有益的，在预防VAP。此外，SSD对迟发性VAP的影响，间歇性和连续性SSD之间的比较，以及SSD在机械通气患者中的安全性应在未来的RCT中进行评价。（J Trauma. 2012;72：1276-1285.版权所有（C）2012 Lippincott威廉姆斯& Wilkins）
BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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. (J Trauma. 2012;72: 1276-1285. Copyright (C) 2012 by Lippincott Williams & Wilkins)