title: Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis.
abstract: OBJECTIVE
  To assess the efficacy of subglottic secretion drainage in preventing ventilator-associated pneumonia.
  
  
  METHODS
  We performed a comprehensive, systematic meta-analysis of randomized trials that have compared subglottic secretion drainage with standard endotracheal tube care in mechanically ventilated patients. Studies were identified by a computerized database search, review of bibliographies, and expert consultation. Summary risk ratios or weighted mean differences with 95% confidence intervals were calculated for each outcome using a fixed-effects model.
  
  
  RESULTS
  Of 110 studies retrieved, five met the inclusion criteria and enrolled 896 patients. Subglottic secretion drainage reduced the incidence of ventilator-associated pneumonia by nearly half (risk ratio [RR] = 0.51; 95% confidence interval [CI]: 0.37 to 0.71), primarily by reducing early-onset pneumonia (pneumonia occurring within 5 to 7 days after intubation). Although significant heterogeneity was found for several endpoints, this was largely resolved by excluding a single outlying study. In the remaining four studies, which recruited patients expected to require >72 hours of mechanical ventilation, secretion drainage shortened the duration of mechanical ventilation by 2 days (95% CI: 1.7 to 2.3 days) and the length of stay in the intensive care unit by 3 days (95% CI: 2.1 to 3.9 days), and delayed the onset of pneumonia by 6.8 days (95% CI: 5.5 to 8.1 days).
  
  
  CONCLUSIONS
  Subglottic secretion drainage appears effective in preventing early-onset ventilator-associated pneumonia among patients expected to require >72 hours of mechanical ventilation.
authors.affiliation: Critical Care Medicine Department, National Institutes of Health, Bethesda, MD 20892, USA. cdezfulian@cc.nih.gov
authors.forename: Cameron
authors.initials: C
authors.lastname: Dezfulian
authors.forename: Kaveh
authors.initials: K
authors.lastname: Shojania
authors.forename: Harold R
authors.initials: HR
authors.lastname: Collard
authors.forename: H Myra
authors.initials: HM
authors.lastname: Kim
authors.forename: Michael A
authors.initials: MA
authors.lastname: Matthay
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
mesh_terms: D016001:Confidence Intervals; D004322:Drainage; D005931:Glottis; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D016017:Odds Ratio; D011014:Pneumonia / Q000209:etiology* / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000009:adverse effects*; D018570:Risk Assessment; D013997:Time Factors