Efficacy of preventive interventions against ventilator-associated pneumonia in critically ill patients: An umbrella review of meta-analyses
Abstract
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).…
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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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