title: Subglottic secretion suction for preventing ventilator-associated pneumonia: an updated meta-analysis and trial sequential analysis.
abstract: Potential benefits of subglottic secretion suction for preventing ventilator-associated pneumonia (VAP) are not fully understood.
  
  
  
  We searched Cochrane Central, PubMed, and EMBASE up to March 2016 to identify randomized controlled trials (RCTs) that compared subglottic secretion suction versus non-subglottic secretion suction in adults with mechanical ventilation. Meta-analysis was conducted using Revman 5.3, trial sequential analysis (TSA) 0.9 and STATA 12.0. The primary outcome was incidence of VAP. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the level of evidence.
  
  
  
  Twenty RCTs (N = 3544) were identified. Subglottic secretion suction was associated with reduction of VAP incidence in four high quality trials (relative risk (RR) 0.54, 95 % confidence interval (CI) 0.40-0.74; p < 0.00001) and in all trials (RR = 0.55, 95 % CI 0.48- 0.63; p < 0.00001). Sensitivity analyses did not show differences in the pooled results. Additionally, the results of the above-mentioned analyses were confirmed in TSA. GRADE level was high. Subglottic secretion suction significantly reduced incidence of early onset VAP, gram-positive or gram-negative bacteria causing VAP, and duration of mechanical ventilation. It delayed the time-to-onset of VAP. However, no significant differences in late onset VAP, intensive care unit (ICU) mortality, hospital mortality, or ICU length of stay were found.
  
  
  
  Subglottic secretion suction decreased VAP incidence and duration of mechanical ventilation and delayed VAP onset. However, subglottic secretion suction did not reduce mortality and length of ICU stay. Subglottic secretion suction is recommended for preventing VAP and for reducing ventilation length, especially in the population at high risk of early onset VAP.
  
  
  
  A protocol of this meta-analysis has been registered on PROSPERO (registration number: CRD42015015715 ); registered on 5 January 2015.
authors: Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China.
authors: Zhi
authors: Z
authors: Mao
authors: Department of Cardiovascular Surgery, Institute of Cardiac Surgery, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
authors: Ling
authors: L
authors: Gao
authors: Department of Orthopaedics Chinese, People's Liberation Army General Hospital, Beijing, People's Republic of China.
authors: Guoqi
authors: G
authors: Wang
authors: Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China.
authors: Chao
authors: C
authors: Liu
authors: Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China.
authors: Yan
authors: Y
authors: Zhao
authors: Department of Anesthesiology, Drum Tower Hospital, Medical College of Nanjing University, Nanjing, China.
authors: Wanjie
authors: W
authors: Gu
authors: Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China.
authors: Hongjun
authors: H
authors: Kang
authors: Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, 28 Fu-Xing Road, Beijing, 100853, People's Republic of China. feihuzhou301@126.com.
authors: Feihu
authors: F
authors: Zhou
mesh_terms: D005931:Glottis / Q000378:metabolism*; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000503:physiopathology / Q000517:prevention & control* / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012121:Respiration, Artificial / Q000009:adverse effects*; D013396:Suction / Q000379:methods
keywords: Meta-analysis; Subglottic secretion suction; Trial sequential analysis; Ventilator-associated pneumonia