RETRACTED: Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Preventing the Risk of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Control Trials
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Eligibility Criteria
2.3. Search Strategy
2.4. Data Extraction and Quality Assessment
2.5. Pooled Analysis
2.6. Subgroup Analysis
3. Results
3.1. Characteristics of Included Studies
3.2. The Outcome of Included Studies
3.2.1. Ventilator-Associated Pneumonia Outcomes
3.2.2. ICU Length of Stay Outcomes
3.2.3. Mortality Outcomes
3.3. Quality of Included Studies
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
References
- Maertens, B.; Lin, F.; Chen, Y.; Rello, J.; Lathyris, D.; Blot, S. Effectiveness of continuous cuff pressure control in preventing ventilator-associated pneumonia: A systematic review and meta-analysis of randomized controlled trials. Crit. Care Med. 2022, 50, 1430–1439. [Google Scholar] [CrossRef] [PubMed]
- Blot, S.; Ruppé, E.; Harbarth, S.; Asehnoune, K.; Poulakou, G.; Luyt, C.-E.; Rello, J.; Klompas, M.; Depuydt, P.; Eckmann, C.; et al. Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive Crit. Care Nurs. 2022, 70, 103227. [Google Scholar]
- Blot, S.; Koulenti, D.; Dimopoulos, G.; Martin, C.; Komnos, A.; Krueger, W.A.; Spina, G.; Armaganidis, A.; Rello, J. Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients. Crit. Care Med. 2014, 42, 601–609. [Google Scholar] [CrossRef]
- Ranzani, O.T.; Niederman, M.S.; Torres, A. Ventilator-associated pneumonia. Intensive Care Med. 2022, 48, 1222–1226. [Google Scholar] [CrossRef]
- Jain, V.; Vashisht, R.; Yilmaz, G.; Bhardwaj, A. Pneumonia Pathology. StatPearls; StatPearls Publishing LLC.: Treasure Island, FL, USA, 2022. [Google Scholar]
- Luo, W.; Xing, R.; Wang, C. The effect of ventilator-associated pneumonia on the prognosis of intensive care unit patients within 90 days and 180 days. BMC Infect. Dis. 2021, 21, 684. [Google Scholar] [CrossRef]
- Heredia-Rodríguez, M.; Peláez, M.T.; Fierro, I.; Gómez-Sánchez, E.; Gómez-Pesquera, E.; Lorenzo, M.; Álvarez-González, F.J.; Bustamante-Munguira, J.; Eiros, J.M.; Bermejo-Martin, J.F.; et al. Impact of ventilator-associated pneumonia on mortality and epidemiological features of patients with secondary peritonitis. Ann. Intensive Care 2016, 6, 34. [Google Scholar] [CrossRef]
- Spapen, H.; Suys, E.; De Regt, J.; Troubleyn, J.; Jonckheer, J.; De Waele, E. An endotracheal tube providing “pressurized sealing” prevents fluid leakage in mechanically ventilated critically ill patients: A pilot study. J. Anesth. 2020, 34, 144–148. [Google Scholar] [CrossRef]
- Wang, F.; Bo, L.; Tang, L.; Lou, J.; Wu, Y.; Chen, F.; Li, J.; Deng, X. Subglottic secretion drainage for preventing ventilator-associated pneumonia: An updated meta-analysis of randomized controlled trials. J. Trauma Acute Care Surg. 2012, 72, 1276–1285. [Google Scholar] [CrossRef] [PubMed]
- Wu, D.; Wu, C.; Zhang, S.; Zhong, Y. Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients. Front. Pharm. 2019, 10, 482. [Google Scholar] [CrossRef]
- Teng, G.; Wang, N.; Nie, X.; Zhang, L.; Liu, H. Analysis of risk factors for early-onset ventilator-associated pneumonia in a neurosurgical intensive care unit. BMC Infect. Dis. 2022, 22, 66. [Google Scholar] [CrossRef]
- Xu, Y.; Lai, C.; Xu, G.; Meng, W.; Zhang, J.; Hou, H.; Pi, H. Risk factors of ventilator-associated pneumonia in elderly patients receiving mechanical ventilation. Clin. Interv. Aging 2019, 14, 1027. [Google Scholar] [CrossRef] [PubMed]
- Rababa, M.; Bani-Hamad, D.; Hayajneh, A.A.; Al Mugheed, K. Nurses’ knowledge, attitudes, practice, and decision-making skills related to sepsis assessment and management. Electron. J. Gen. Med. 2022, 19, em420. [Google Scholar] [CrossRef] [PubMed]
- Al-Mugheed, K.; Bani-Issa, W.; Rababa, M.; Hayajneh, A.A.; Al Syouf, A.; Al-Bsheish, M.; Jarrar, M. Knowledge, practice, compliance, and barriers toward ventilator-associated pneumonia among critical care nurses in eastern mediterranean region: A systematic review. Healthcare 2022, 10, 1852. [Google Scholar] [CrossRef]
- Alkhazali, M.; Bayraktar, N.; Al-Mugheed, K. Knowledge and Barriers of Critical Care Nurses Regarding Evidence-Based Practices in Ventilator-Associated Pneumonia Prevention. Cyprus J. Med. Sci. 2021, 3, 185–191. [Google Scholar] [CrossRef]
- Pozuelo-Carrascosa, D.P.; Herráiz-Adillo, Á.; Alvarez-Bueno, C.; Añón, J.M.; Martínez-Vizcaíno, V.; Cavero-Redondo, I. Subglottic secretion drainage for preventing ventilator-associated pneumonia: An overview of systematic reviews and an updated meta-analysis. Eur. Respir. Rev. 2020, 29, 190107. [Google Scholar] [CrossRef] [PubMed]
- Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Syst. Rev. 2021, 10, 105906. [Google Scholar] [CrossRef]
- Higgins, J.P.; Thompson, S.G.; Deeks, J.J.; Altman, D.G. Measuring inconsistency in meta-analyses. BMJ 2003, 327, 557–560. [Google Scholar] [CrossRef]
- Akdogan, O.; Ersoy, Y.; Kuzucu, C.; Gedik, E.; Togal, T.; Yetkin, F. Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization. Braz. J. Infect. Dis. 2017, 21, 276–281. [Google Scholar] [CrossRef]
- Chai, C.; Liu, X.; Zhao, Y. The effect of different solutions in tracheal suctioning on the incidence of pneumonia in patients on the ventilator. Cell. Mol. Biol. 2022, 68, 197–202. [Google Scholar] [CrossRef]
- Chen, G.; Wang, J.; Liu, C.; Xu, R.; Li, Q.; Zhou, X.; Gan, X. Subglottic secretion drainage and semi-recumbent position for preventing ventilator associated pneumonia. Int. J. Clin. Exp. Med. 2016, 9, 5193–5198. [Google Scholar]
- Chow, M.C.; Kwok, S.-M.; Luk, H.-W.; Law, J.W.; Leung, B.P. Effect of continuous oral suctioning on the development of ventilator-associated pneumonia: A pilot randomized controlled trial. Int. J. Nurs. Stud. 2012, 49, 1333–1341. [Google Scholar] [CrossRef] [PubMed]
- Damas, P.; Frippiat, F.; Ancion, A.; Canivet, J.L.; Lambermont, B.; Layios, N.; Massion, P.; Morimont, P.; Nys, M.; Piret, S.; et al. Prevention of ventilator-associated pneumonia and ventilator-associated conditions: A randomized controlled trial with subglottic secretion suctioning. Crit. Care Med. 2015, 43, 22–30. [Google Scholar] [CrossRef] [PubMed]
- Deem, S.; Yanez, D.; Sissons-Ross, L.; Elrod Broeckel, J.A.; Daniel, S.; Treggiari, M. Randomized pilot trial of two modified endotracheal tubes to prevent ventilator-associated pneumonia. Ann. Am. Thorac. Soc. 2016, 13, 72–80. [Google Scholar] [CrossRef] [PubMed]
- Gopal, S.; Luckraz, H.; Giri, R.; Nevill, A.; Muhammed, I.; Reid, M.; Bickerton, S.; Jenkins, D. Significant reduction in ventilator-associated pneumonia with the Venner-PneuX System in high-risk patients undergoing cardiac surgery: The Low Ventilator-Associated-Pneumonia study. Eur. J. Cardio-Thorac. Surg. 2015, 47, e92–e6. [Google Scholar] [CrossRef]
- Ravikumar, R.; Masapu, D.; Jena, S.; Kamath, S.; Veenakumari, H.B.; Ramesh, V.J.; Bhadrinarayan, V. Comparison of suction above cuff and standard endotracheal tubes in neurological patients for the incidence of ventilator-associated pneumonia and in-hospital outcome: A randomized controlled pilot study. Indian J. Crit. Care Med. 2016, 20, 261. [Google Scholar] [CrossRef]
- Mahmoodpoor, A.; Peyrovi-Far, A.; Hamishehkar, H.; Bakhtyiari, Z.; Mirinezhad, M.M.; Hamidi, M.; Golzari, S. Comparison of prophylactic effects of polyurethane cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes on ventilator-associated pneumonia. Acta Med. Iran. 2013, 51, 461–466. [Google Scholar]
- Mahmoodpoor, A.; Hamishehkar, H.; Hamidi, M.; Shadvar, K.; Sanaie, S.; Golzari, S.E.; Khan, Z.H.; Nader, N.D. A prospective randomized trial of tapered-cuff endotracheal tubes with intermittent subglottic suctioning in preventing ventilator-associated pneumonia in critically ill patients. J. Crit. Care 2017, 38, 152–156. [Google Scholar] [CrossRef]
- Mahmoodpoor, A.; Sanaie, S.; Parthvi, R.; Shadvar, K.; Hamishekar, H.; Iranpour, A.; Nuri, H.; Rahnemayan, S.; Nader, N.D. A clinical trial of silver-coated and tapered cuff plus supraglottic suctioning endotracheal tubes in preventing ventilator-associated pneumonia. J. Crit. Care 2019, 56, 171–176. [Google Scholar] [CrossRef]
- Mansoor, M.; Farid, Z.; Golnar, S.; Behzad, M.; Mohsen, S. Early replacement of conventional endotracheal tube with endotracheal tube with subglottic suction port for the new intensive care patients; preventive or problematic against ventilator associated events? J. Pure Appl. Microbiol. 2016, 10, 2655–2662. [Google Scholar] [CrossRef]
- Naghibi, T.; Akbari, Z.; Sabet, S.A.; Dobakhti, F. Effect of intermittent subglottic irrigation with 5% nacl on the prevention of ventilator associated pneumonia in critically ill patients. Tanaffos 2019, 18, 152. [Google Scholar]
- Philippart, F.; Gaudry, S.; Quinquis, L.; Lau, N.; Ouanes, I.; Touati, S.; Nguyen, J.C.; Branger, C.; Faibis, F.; Mastouri, M.; et al. Randomized intubation with polyurethane or conical cuffs to prevent pneumonia in ventilated patients. Am. J. Respir. Crit. Care Med. 2015, 191, 637–645. [Google Scholar] [CrossRef]
- Seyfi, S.; Latifi, S.; Shirkhani, Z. Effect of Subglottic Secretion Drainage on theVentilator-Associated Pneumonia in ICU Patients. J. Babol Univ. Med. Sci. 2013, 15, 58–62. [Google Scholar]
- Tao, Z.; Zhao, S.; Yang, G.; Wang, L.; Zhu, S. Effect of two methods of subglottic secretion drainage on the incidence of ventilator-associated pneumonia. Chin. J. Tuberc. Respir. Dis. 2014, 37, 283–286. [Google Scholar]
- Qiao, Z.; Yu, J.; Yu, K.; Zhang, M. The benefit of daily sputum suction via bronchoscopy in patients of chronic obstructive pulmonary disease with ventilators: A randomized controlled trial. Medicine 2018, 97, e11631. [Google Scholar] [CrossRef] [PubMed]
- Chair, S.Y.; Chan, D.W.K.; Cao, X. The interaction of subglottic drainage, cuff pressure, and oral care on endotracheal tube fluid leakage: A benchtop study. Aust. Crit. Care 2020, 33, 358–363. [Google Scholar] [CrossRef] [PubMed]
- Caroff, D.A.; Li, L.; Muscedere, J.; Klompas, M. Subglottic Secretion Drainage and Objective Outcomes: A Systematic Review and Meta-Analysis. Crit. Care Med. 2016, 44, 830–840. [Google Scholar] [CrossRef] [PubMed]
- Mao, Z.; Gao, L.; Wang, G.; Liu, C.; Zhao, Y.; Gu, W.; Kang, H.; Zhou, F. Subglottic secretion suction for preventing ventilator-associated pneumonia: An updated meta-analysis and trial sequential analysis. Crit. Care 2016, 20, 353. [Google Scholar] [CrossRef]
- Muscedere, J.; Rewa, O.; Mckechnie, K.; Jiang, X.; Laporta, D.; Heyland, D.K. Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: A systematic review and meta-analysis. Crit. Care Med. 2011, 39, 1985–1991. [Google Scholar] [CrossRef]
- Branch-Elliman, W.; Wright, S.B.; Howell, M.D. Determining the ideal strategy for ventilator-associated pneumonia prevention. Cost–benefit analysis. Am. J. Respir. Crit. Care Med. 2015, 192, 57–63. [Google Scholar] [CrossRef]
- Melsen, W.G.; Rovers, M.M.; Groenwold, R.; Bergmans, D.C.; Camus, C.; Bauer, T.T.; Hanisch, E.; Klarin, B.; Koeman, M.; Krueger, W.A.; et al. Attributable mortality of ventilator-associated pneumonia: A meta-analysis of individual patient data from randomised prevention studies. Lancet Infect. Dis. 2013, 13, 665–671. [Google Scholar] [CrossRef]
- Powell, J.; Garnett, J.P.; Mather, M.W.; Cooles, F.A.H.; Nelson, A.; Verdon, B.; Scott, J.; Jiwa, K.; Ruchaud-Sparagano, M.-H.; Cummings, S.P.; et al. Excess mucin impairs subglottic epithelial host defense in mechanically ventilated patients. Am. J. Respir. Crit. Care Med. 2018, 198, 340–349. [Google Scholar] [CrossRef] [PubMed]
- Priambodo, A.; Mediani, H.S.; Emaliyawati, E. The Implementation of Inspiratory Muscle Training to Enhance Weaning from Mechanical Ventilation: A Systematic Literature Review. J. Plb. Nurs. Stud. 2022, 1, 16–22. [Google Scholar] [CrossRef]
- Gunawan, G.; Nihayati, H.E.; Puspitasari, L.; Machrus, M.A. Nurses Barrier: A Patient Safety Concern in The Intensive Care Unit. J. Plb. Nurs. Stud. 2022, 1, 25–27. [Google Scholar] [CrossRef]
- Nseir, S.; Martin-Loeches, I.; Povoa, P.; Metzelard, M.; Du Cheyron, D.; Lambiotte, F.; Tamion, F.; Labruyere, M.; Makris, D.; Boulle Geronimi, C.; et al. Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: A planned ancillary analysis of the coVAPid cohort. Crit. Care 2021, 25, 177. [Google Scholar] [CrossRef]
- Shamsizadeh, M.; Fathi Jouzdani, A.; Rahimi-Bashar, F. Incidence and Risk Factors of Ventilator-Associated Pneumonia among Patients with Delirium in the Intensive Care Unit: A Prospective Observational Study. Crit. Care Res. Pract. 2022, 2022, 4826933. [Google Scholar] [CrossRef]
- He, Q.; Wang, W.; Zhu, S.; Wang, M.; Kang, Y.; Zhang, R.; Zou, K.; Zong, Z.; Sun, X. The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: An observational study. Crit. Care 2021, 25, 44. [Google Scholar] [CrossRef]
- Klompas, M.; Branson, R.; Cawcutt, K.; Crist, M.; Eichenwald, E.C.; Greene, L.R.; Lee, G.; Maragakis, L.L.; Powell, K.; Priebe, G.P.; et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect. Control. Hosp. Epidemiol. 2022, 43, 687–713. [Google Scholar] [CrossRef]
- Suys, E.; Nieboer, K.; Stiers, W.; De Regt, J.; Huyghens, L.; Spapen, H. Intermittent subglottic secretion drainage may cause tracheal damage in patients with few oropharyngeal secretions. Intensive Crit. Care Nurs. 2013, 29, 317–320. [Google Scholar] [CrossRef]
- Yiating, L.; Yaochen, W. The association of subglottic secretion drainage and tracheal mucosa injury. Eur. Respir. Soc. 2020, 6, 27. [Google Scholar]
- Righy, C.; do Brasil, P.E.A.; Vallés, J.; Bozza, F.A.; Martin-Loeches, I. Systemic antibiotics for preventing ventilator-associated pneumonia in comatose patients: A systematic review and meta-analysis. Ann. Intensive Care 2017, 7, 67. [Google Scholar] [CrossRef]
Study | Design | Location | Setting | Age (Mean SD) | Gender (Male %) | Intervention of Treatment Group | Method of SSD |
---|---|---|---|---|---|---|---|
Akdogan et al. (2017) [19] | RCT | Turkey | Anesthesiology ICU | IG: 60.32 (21.55) CG: 61.34 (19.78) | IG: 28 (75.68) CG: 52 (54.17) | Endotracheal tube with subglottic drainage and cuff pressure monitorization | Continuous |
Chai et al. (2022) [20] | RCT | China | ICU | - | CG: 24 (40%) IG: 28 (46.66%) | suction with 0.9% normal saline with 5% inhaled eucalyptus | - |
Chen et al. (2016) [21] | RCT | China | ICU | IG: 51.8 (12.0) CG: 51.8 (12.1) | IG: 16 CG: 25 | subglottic secretion drainage | - |
Chow et al. (2012) [22] | Pilot RCT | Iran | Surgical ICU | IG: 70.3 (14.3) CG: 79.4 (12.5) | 56 | SSD with the saliva ejector tube | Continuous |
Damas et al. (2015) [23] | RCT | Belgium | ICU | IG: 66 (55–75) CG: 65 (55–75) | IG: 107 CG: 127 | Subglottic secretion suctioning | - |
Deem et al. (2016) [24] | Pilot RCT | USA | ICU | IG: 55 (17) CG: 53 (16) | 10 | Polyurethane-cuffed tube equipped with a port for continuous aspiration of subglottic secretions (PUC-CASS-ETT) | Continuous |
Gopal et al. (2015) [25] | RCT | UK | Surgical and Cardiac ICU | IG: 72.4 (8.2) CG: 72.1 (7.4) | n = 699 | SSD with Venner- PneuX tube | Intermittent |
Jena et al. (2016) [26] | Pilot RCT | India | Neurological ICU | IG: 36.9 (12.8) CG: 42.2 (17.9) | 32 | Suction above cuff endotracheal tube (SACETT) | - |
Mahmoodpoor et al. (2013) [27] | RCT | Iran | Surgical ICU | IG: 54.00 (19.49) CG: 55.71 (19.39) | 67.2 | Taperguard- Polyurethane cuff with the continuous aspiration of subglottic secretions | - |
Mahmoodpoor et al. (2013) [27] | RCT | Iran | Surgical ICU | IG: 57.31 (19.77) CG: 55.71 (19.39) | 64 | Sealguard- Polyurethane cuff with continuous aspiration of subglottic secretions | - |
Mahmoodpoor et al. (2017) [28] | A prospective randomized trial | Iran | ICU | IG: 54.0 (19.2) CG: 54.5 (18.1) | IG: 102 CG: 84 | Evac tube | Intermitten |
Mahmoodpoor et al. (2020) [29] | RCT | Iran | ICU | 55 | 72.8 | Polyurethane cuff with continuous aspiration of subglottic secretions | - |
Mansoor et al. (2016) [30] | RCT | Iran | ICU | IG: 38.24 (24.71) CG: 43.35 (24.71) | IG: 27 CG: 19 | Endotracheal tube with subglottic suction port (Mallinckrodt™ TaperGuard Evac Oral Tracheal Tube; Covidien, Mexico) | Intermittent |
Naghibi et al. (2019) [31] | A randomized, double-blind, placebo-controlled trial | Iran | ICU | IG: 38 (14) CG: 45.57 (14.53) | IG: 10 CG: 9 | SSD with sodium chloride | Intermittent |
Philippart et al. (2015)-a [32] | A multicenter, prospective, open-label RCT | France and Tunisia | medical-surgical ICUs | 65.6 (53.0–77.2) | IG: 83 CG: 92 | PVC, Cylindrical | Continuous |
Philippart et al. (2015)-b [32] | a multicenter, prospective, open-label RCT | France and Tunisia | medical-surgical ICUs | 63.2 (53.4–76.4) | IG: 91 CG: 96 | PVC, Conical | Continuous |
Seyfi et al. (2013) [33] | RCT | Iran | ICU | - | - | SSD | - |
Tao et al. (2014) [34] | RCT | China | ICU | - | - | SSD | Intermittent and continuous |
Qiao et al. (2018) [35] | RCT | China | ICU | IG: 65.1 (5.6) CG: 64.6 (7.6) | IG: 25 CG: 23 | Bronchoscopic sputum suction | Continuous |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Dewi, Y.S.; Arifin, H.; Pradipta, R.O.; Qona’ah, A.; Rosita, R.; Giatin, C.N.; Dawod Kamel Gauda, A. RETRACTED: Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Preventing the Risk of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Control Trials. Medicina 2023, 59, 283. https://doi.org/10.3390/medicina59020283
Dewi YS, Arifin H, Pradipta RO, Qona’ah A, Rosita R, Giatin CN, Dawod Kamel Gauda A. RETRACTED: Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Preventing the Risk of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Control Trials. Medicina. 2023; 59(2):283. https://doi.org/10.3390/medicina59020283
Chicago/Turabian StyleDewi, Yulis Setiya, Hidayat Arifin, Rifky Octavia Pradipta, Arina Qona’ah, Rosita Rosita, Cindy Nanda Giatin, and Amel Dawod Kamel Gauda. 2023. "RETRACTED: Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Preventing the Risk of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Control Trials" Medicina 59, no. 2: 283. https://doi.org/10.3390/medicina59020283