Efficacy of Subglottic Suctioning in the Prevention of Ventilator- Associated Pneumonia among Intensive Care Unit Adult Patients

Abstract

Background: Ventilator-associated pneumonia (VAP) is a common complication of invasive ventilation. It is defined as pneumonia occurring 48-hours or more after the initiation of mechanical ventilation. VAP increases the ICU length of stay and mortality rates, resulting in significant healthcare and financial burdens. The VAP bundle is a collection of strategies designed for its prevention. Among these, subglottic secretion drainage (SSD) has been proposed as an effective tool in reducing the incidence of VAP. However, its adoption and effectiveness remain subjects of ongoing debate within the medical community. Aim: This review aims to present a structured appraisal of the efficacy of SSD on its ability to impact VAP rate, ICU length of stay, and mortality. Methods: A systematic literature search across four databases was undertaken to identify studies that satisfied the predefined inclusion and exclusion criteria. The research question was developed using the PICO model. The quality of the included studies was evaluated through the CASP checklist. Results: After evaluating the ten included RCTs with a total of 2,354 participants, eight studies demonstrated a statistically significant decrease in the incidence of VAP. All included studies assessed mortality, but none found a statistically significant reduction. Of the nine studies that assessed ICU length of stay, only one showed a statistically significant reduction in the SSD group. Conclusion: This review concludes, based on the studies appraised, that SSD is effective in reducing the incidence of VAP among adult ICU patients undergoing mechanical ventilation. SSD did not demonstrably reduce ICU length of stay or mortality. Further work is required to evaluate the cost-effectiveness of SSD and its potential to reduce antimicrobial burden independent of ICU length of stay.