OBJECTIVES: 

Microaspiration of subglottic secretions is the main pathogenic mechanism for ventilator-associated pneumonia (VAP). Adequate inflation of the endotracheal cuff is pivotal to providing an optimal seal of the extraluminal airway. However, cuff pressure substantially fluctuates due to patient or tube movements, which can induce microaspiration. Therefore, devices for continuous cuff pressure control (CCPC) have been developed in recent years. The purpose of this systematic review and meta-analysis is to assess the effectiveness of CCPC in VAP prevention.

DATA SOURCES: 

A systematic search of Embase, the Cochrane Central Register of Controlled Trials, and the International Clinical Trials Registry Platform was conducted up to February 2022.

STUDY SELECTION: 

Eligible studies were randomized controlled trials (RCTs) and quasi-RCTs comparing the impact of CCPC versus intermittent cuff pressure control on the occurrence of VAP.

DATA EXTRACTION: 

Random-effects meta-analysis was used to calculate odds ratio (OR) and 95% CI for VAP incidence between groups. Secondary outcome measures included mortality and duration of mechanical ventilation (MV) and ICU stay. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.

DATA SYNTHESIS: 

Eleven RCTs with 2,092 adult intubated patients were included. The use of CCPC was associated with a reduced risk of VAP (OR, 0.51). Meta-analyses of secondary endpoints showed no significant difference in mortality but significant differences in durations of MV (mean difference, –1.07 d) and ICU stay (mean difference, –3.41 d) in favor of CCPC. However, the risk of both reporting and individual study bias was considered important. The main issues were the lack of blinding, potential commercial conflicts of interest of study authors and high heterogeneity due to methodological differences between studies, differences in devices used for CCPC and in applied baseline preventive measures. Certainty of the evidence was considered “very low.”

CONCLUSIONS: 

The use of CCPC was associated with a reduction in VAP incidence; however, this was based on very low certainty of evidence due to concerns related to risk of bias and inconsistency.

中文翻译：

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连续袖带压力控制在预防呼吸机相关肺炎中的有效性：随机对照试验的系统回顾和荟萃分析*

目标： 

声门下分泌物的微抽吸是呼吸机相关性肺炎（VAP）的主要致病机制。气管内套囊的充分充气对于提供腔外气道的最佳密封至关重要。然而，袖带压力会因患者或导管运动而大幅波动，这可能会引起微抽吸。因此，近年来开发了连续袖带压力控制装置（CCPC）。本系统评价和荟萃分析的目的是评估 CCPC 在预防 VAP 方面的有效性。

数据源： 

截至 2022 年 2 月，对 Embase、Cochrane 对照试验中央注册中心和国际临床试验注册平台进行了系统检索。

研究选择： 

符合条件的研究是随机对照试验 (RCT) 和准随机对照试验，比较 CCPC 与间歇性袖带压力控制对 VAP 发生的影响。

数据提取： 

使用随机效应荟萃分析来计算组间 VAP 发生率的比值比 (OR) 和 95% CI。次要结果指标包括死亡率、机械通气 (MV) 持续时间和 ICU 住院时间。使用建议评估、制定和评价分级方法对证据的确定性进行了评估。

数据综合： 

纳入了 11 项随机对照试验，涉及 2,092 名成人插管患者。CCPC 的使用与 VAP 风险降低相关（OR，0.51）。次要终点的荟萃分析显示死亡率没有显着差异，但 MV 持续时间（平均差，–1.07 d）和 ICU 住院时间（平均差，–3.41 d）有显着差异，有利于 CCPC。然而，报告和个人研究偏倚的风险被认为很重要。主要问题是缺乏盲法、研究作者潜在的商业利益冲突以及由于研究之间的方法差异、CCPC 使用的设备和所应用的基线预防措施的差异而导致的高度异质性。证据的质量被认为“非常低”。

结论： 

CCPC 的使用与 VAP 发病率的降低有关；然而，出于对偏倚和不一致风险的担忧，这是基于非常低的证据质量。