Background

Many meta-analyses have assessed the efficacy of preventive interventions against ventilator-associated pneumonia (VAP) in critically ill patients. However, there has been no comprehensive analysis of the strength and quality of evidence to date.

Methods

Systematic reviews of randomized and quasi-randomized controlled trials, which evaluated the effect of preventive strategies on the incidence of VAP in critically ill patients receiving mechanical ventilation for at least 48 h, were enrolled in this article.

Results

We identified a sum of 34 interventions derived from 31 studies. Among these interventions, 19 resulted in a significantly reduced incidence of VAP. Among numerous strategies, only selective decontamination of the digestive tract (SDD) was supported by highly suggestive (class II) evidence (risk ratio [RR] = 0.439, 95% CI: 0.362, 0.532). Based on data from the sensitivity analysis, the evidence for the efficacy of non-invasive ventilation in weaning from mechanical ventilation (NIV) was upgraded from weak (class IV) to highly suggestive (class II) (RR = 0.32, 95% CI: 0.22, 0.46). All preventive interventions were not supported by robust evidence for reducing mortality. Early mobilization (EM) exhibited suggestive (class III) evidence in shortening both intensive length of stay (LOS) in the intensive care unit (ICU) (mean difference [MD] = -0.85, 95% CI: -1.21, -0.49) and duration of mechanical ventilation (MV) (MD = -1.02, 95% CI: -1.41, -0.63).

Conclusions

SDD and NIV are supported by robust evidence for prevention against VAP, while EM has been shown to significantly shorten the LOS in the ICU and the duration of MV. These three strategies are recommendable for inclusion in the ventilator bundle to lower the risk of VAP and improve the prognosis of critically ill patients.

中文翻译：

---

重症患者呼吸机相关性肺炎预防性干预措施的有效性：荟萃分析的综合评价

背景

许多荟萃分析评估了重症患者呼吸机相关性肺炎（VAP）预防干预措施的有效性。然而，迄今为止尚未对证据的强度和质量进行全面分析。

方法

本文纳入了随机和半随机对照试验的系统评价，这些试验评估了预防策略对接受机械通气至少 48 小时的危重患者 VAP 发生率的影响。

结果

我们从 31 项研究中总共确定了 34 项干预措施。在这些干预措施中，有 19 项干预措施显着降低了 VAP 的发生率。在众多策略中，只有选择性消化道净化（SDD）得到了高度提示性（II 类）证据的支持（风险比 [RR] = 0.439，95% CI：0.362，0.532）。根据敏感性分析的数据，无创通气在机械通气 (NIV) 脱机中的有效性证据从弱（IV 级）升级为高度提示性（II 级）（RR = 0.32，95% CI： 0.22、0.46）。所有预防性干预措施均没有降低死亡率的有力证据支持。早期活动 (EM) 在缩短重症监护病房 (ICU) 的强化住院时间 (LOS) 方面表现出提示性（III 级）证据（平均差 [MD] = -0.85，95% CI：-1.21，-0.49）和机械通气持续时间 (MV)（MD = -1.02，95% CI：-1.41，-0.63）。

结论

SDD 和 NIV 有预防 VAP 的有力证据支持，而 EM 已被证明可以显着缩短 ICU 的 LOS 和 MV 的持续时间。建议将这三种策略纳入呼吸机组合中，以降低 VAP 风险并改善危重患者的预后。