title: Continuous control of tracheal cuff pressure for VAP prevention: a collaborative meta-analysis of individual participant data.
abstract: BACKGROUND
  Underinflation of tracheal cuff is a risk factor for microaspiration of contaminated secretions and subsequent ventilator-associated pneumonia (VAP). The aim of this collaborative meta-analysis of individual participant data is to determine the impact of continuous control of P cuff on the incidence of VAP.
  
  
  METHODS
  Studies were identified by searching PubMed and references of relevant articles. Data from 3 prospective controlled trials (two randomized and one quasi-randomized), which evaluated the impact of continuous control of P cuff on the incidence of VAP, were obtained and pooled together. Three different devices were used to continuously control P cuff. VAP was diagnosed using clinical, radiologic, and quantitative microbiological criteria. The impact of continuous control of P cuff on VAP was assessed by Cox regression analysis, stratified on trial.
  
  
  RESULTS
  263 (48.4 %) patients received continuous control of P cuff, and 280 (51.5 %) patients received routine control of P cuff using a manometer. 36 (13.6 %) VAP were diagnosed in continuous control group, and 72 (25.7 %) in routine care group (HR 0.47, 95 % CI 0.31-0.71, p < 0.001). However, heterogeneity was apparent in continuous control effect size across trials (I (2) = 58 %, p = 0.085). The number of patients needed to treat to prevent one VAP episode was 8. No significant impact of continuous control of P cuff was found on duration of mechanical ventilation, ICU length of stay, or mortality.
  
  
  CONCLUSIONS
  Continuous control of P cuff might be beneficial in reducing the risk for VAP. However, no significant impact of continuous control of P cuff was found on duration of mechanical ventilation, ICU length of stay, or mortality.
authors.affiliation: CHU Lille, Centre de Réanimation, 59000, Lille, France. s-nseir@chru-lille.fr.|Faculté de Médecine, Université Lille, 59000, Lille, France. s-nseir@chru-lille.fr.
authors.forename: Saad
authors.initials: S
authors.lastname: Nseir
authors.affiliation: Intensive Care Unit, Hospital Universitario de Canarias, Tenerife, La Laguna, Spain. lorentemartin@msn.com.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lorente
authors.affiliation: Respiratory Intensive and Intermediate Care Unit, Department of Pneumology, Hospital Clinic, Institute of Thorax, Barcelona, Spain. mferrer@clinic.ub.es.
authors.forename: Miquel
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: CHU Lille, Centre de Réanimation, 59000, Lille, France. anahita.rouze@chru-lille.fr.
authors.forename: Anahita
authors.initials: A
authors.lastname: Rouzé
authors.affiliation: Intensive Care Unit, Hospital Universitario de Canarias, Tenerife, La Laguna, Spain. oswaldojglez@gmail.com.
authors.forename: Oswaldo
authors.initials: O
authors.lastname: Gonzalez
authors.affiliation: Respiratory Intensive and Intermediate Care Unit, Department of Pneumology, Hospital Clinic, Institute of Thorax, Barcelona, Spain. glibassi@clinic.ub.es.
authors.forename: Gianluigi Li
authors.initials: GL
authors.lastname: Bassi
authors.affiliation: Faculté de Médecine, Université Lille, 59000, Lille, France. alain.duhamel59@gmail.com.|Epidemiology, Public Health and Quality of Care, Nord-de-France University, Lille, France. alain.duhamel59@gmail.com.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Respiratory Intensive and Intermediate Care Unit, Department of Pneumology, Hospital Clinic, Institute of Thorax, Barcelona, Spain. atorres@clinic.ub.es.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
keywords: Critical care; Cuff pressure; Mechanical ventilation; Meta-analysis; Microaspiration; Pneumonia