Continuous control of tracheal cuff pressure for VAP prevention: a collaborative meta-analysis of individual participant data

Background

Underinflation of tracheal cuff is a risk factor for microaspiration of contaminated secretions and subsequent ventilator-associated pneumonia (VAP). The aim of this collaborative meta-analysis of individual participant data is to determine the impact of continuous control of P _cuff on the incidence of VAP

Methods

Studies were identified by searching PubMed and references of relevant articles. Data from 3 prospective controlled trials (two randomized and one quasi-randomized), which evaluated the impact of continuous control of P _cuff on the incidence of VAP, were obtained and pooled together. Three different devices were used to continuously control P _cuff. VAP was diagnosed using clinical, radiologic, and quantitative microbiological criteria. The impact of continuous control of P _cuff on VAP was assessed by Cox regression analysis, stratified on trial

Results

263 (48.4 %) patients received continuous control of P _cuff, and 280 (51.5 %) patients received routine control of P _cuff using a manometer. 36 (13.6 %) VAP were diagnosed in continuous control group, and 72 (25.7 %) in routine care group (HR 0.47, 95 % CI 0.31–0.71, p  < 0.001). However, heterogeneity was apparent in continuous control effect size across trials ( I ^2 = 58 %, p  = 0.085). The number of patients needed to treat to prevent one VAP episode was 8. No significant impact of continuous control of P _cuff was found on duration of mechanical ventilation, ICU length of stay, or mortality. Conclusion Continuous control of P _cuff might be beneficial in reducing the risk for VAP. However, no significant impact of continuous control of P _cuff was found on duration of mechanical ventilation, ICU length of stay, or mortality.