Fiberoptic bronchoscopy for the prevention of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials
Abstract
INTRODUCTION
Ventilator-associated pneumonia (VAP) causes increased time of mechanical ventilation (MV), prolonged intensive care unit (ICU) stay, and a higher mortality risk. The systematic review and meta-analysis aimed to compare the efficacies between fiberoptic bronchoscopy (FOB) and general sputum suction for the prevention of VAP in patients with invasive MV.
METHODOLOGY
Relevant randomized controlled trials (RCTs) were obtained via a search of PubMed, Embase, Cochrane Library, Wanfang, and CNKI databases. A random-effects model was used to pool the results if significant heterogeneity was observed. Otherwise, a fixed-effects model was used.
RESULTS
Sixteen RCTs were included. Compared to general sputum suction, sputum suction with FOB was associated with a significantly reduced risk of VAP (risk ratio [RR]: 0.56, 95% CI: 0.47 to 0.67, p < 0.001; I2 = 0%). Subgroup analyses showed that the combination of FOB-assisted sputum suction with bronchoalveolar lavage (BAL) further reduced the risk of VAP as compared to FOB-assisted sputum suction alone (p for subgroup difference = 0.04). In addition, FOB-assisted treatment was also associated with a reduced MV time (mean difference [MD]: -2.19 days, 95% CI: -2.69 to -1.68, p < 0.001; I2 = 18%), a shorter ICU stay (MD: 2.9 days, 95% CI: -3.68 to -2.13, p < 0.001; I2 = 34%), and a reduced mortality risk (RR: 0.46, 95% CI: 0.24 to 0.90, p = 0.02; I2 = 0%) in patients with invasive MV.
CONCLUSIONS
FOB for sputum suction and BAL…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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