Subglottic Secretion Drainage to Prevent Ventilator-Associated Pneumonia in Mechanically Ventilated Adult Patients: A Systematic Review and Meta-Analysis

Background: Patients requiring invasive mechanical ventilation in the intensive care unit (ICU) are at risk for ventilator-associated pneumonia (VAP).Objectives: To summarize the results of published, randomized, clinical trials (RCTs), a meta-analysis was performed to examine the effect of subglottic secretion drainage (SSD) on the prevalence and outcomes of VAP in adult patients undergoing mechanical ventilation.Methods: A comprehensive search based on specific terms was performed as a systematic review and meta-analysis by a computerized database search in the national and international databases including MagIran, SID, Scopus, PubMed, ISI Web of Knowledge, ScienceDirect, Google Scholar, Cochrane Central, and IRCT as well as references from ۱۹۹۰ to ۲۰۱۸ in English and Persian languages. RCTsof SSDwere considered as common careof adultpatientsundergoingmechanical ventilationin the currentmeta-analysis. Data analysis was carried out through the random and fixed effects model, and the heterogeneity was investigated by I۲ and Q-Cochrane index. The data were analyzed using STATA ۱۱.Results: A total of ۲۴ eligible RCTs with ۲۴۳۴ patients were identified. The overall risk ratio for VAP was ۱۴.۷ (۹۵% confidence interval (CI): ۱۱.۱ - ۱۸.۴); mortality ۲۵.۸ (۹۵% CI: ۱۷.۳ - ۳۴.۳); length of ICU stay ۱۳.۴ (۹۵% CI: ۷.۸ - ۱۸.۹) and hospital stay ۲۳.۲ (۹۵% CI: ۱۲.۵ - ۳۳.۹); ventilation days ۱۴.۹ (۹۵% CI: ۷.۳ - ۲۲.۶); airway secretion ۱۰.۲ (۹۵% CI: ۴.۹ - ۱۵.۵); and APACHEII ۱۹.۵ (۹۵% CI: ۱۴.۶ - ۲۴.۳).Conclusions: SSD is recommended to prevent VAP, and reduce mortality rate and the ICU LOS, especially in the high-risk patients undergoing mechanical ventilation for a long period of time.