Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis

Am J Med. 2005 Jan;118(1):11-8. doi: 10.1016/j.amjmed.2004.07.051.


Purpose: 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).

Conclusion: Subglottic secretion drainage appears effective in preventing early-onset ventilator-associated pneumonia among patients expected to require >72 hours of mechanical ventilation.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Confidence Intervals
  • Drainage*
  • Glottis
  • Humans
  • Intubation, Intratracheal / adverse effects
  • Odds Ratio
  • Pneumonia / etiology*
  • Pneumonia / prevention & control*
  • Randomized Controlled Trials as Topic
  • Respiration, Artificial / adverse effects*
  • Risk Assessment
  • Time Factors