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Table 1 Characteristics of included studies

From: Subglottic secretion suction for preventing ventilator-associated pneumonia: an updated meta-analysis and trial sequential analysis

Study Population (n) Settings Definition of VAP Inclusion criteria Exclusion criteria Method of SSS Antibiotic use Evaluation unit of antibiotic consumption
Mahul, 1992 [30] 145 Medical-surgical ICU Positive bronchoalveolar lavage culture required Expected duration of MV >3 days Gastrointestinal bleeding, tracheostomy, risk of reintubation, intubated before ICU Intermittent Antibiotic use at randomization not reported NA
Valles, 1995 [31] 153 Medical-surgical ICU Clinical features confirmed with bronchoscopically obtained cultures Expected duration of MV >3 days Intubated before arriving at the emergency department or ICU; tracheostomy Continuous Patients receiving antibiotics at time of randomization: 64 % and 58 %, intervention and control group respectively NA
Kollef, 1999 [32] 343 Cardiothoracic ICU Clinical features, positive tracheal, blood, or pleural cultures; radiographic abscess, or positive histology Need for MV after cardiac surgery Intubated before ICU; transfer from outside hospital Continuous Antibiotics were given to 99 % and 98 % of intervention and control patients, respectively NA
Bo, 2000 [33] 68 Surgical ICU Clinical features or positive blood/pleural cultures Expected duration of MV >72 h Intubated outside hospital; high-risk surgery or trauma; pre-existing infection Continuous Antibiotics were used in 29 % of intervention group and 36 % of control group NA
Smulders, 2002 [34] 150 Medical-surgical ICU Clinical features or positive blood/pleural cultures Expected duration of MV >72 h Patients expected to require >72 h MV Intermittent 48 % of intervention group and 51 % of control group were receiving antibiotics NA
Girou, 2004 [35] 18 NA Clinical features and significant quantitative culture of aspiration Expected duration of MV >5 days NA Continuous Prior antibiotic therapy: 1 patient in suctioning group and 4 patients in control group NA
Liu SH, 2006 [37] 98 Respiratory ICU MV >48 h, the chest X-ray showed pulmonary new or progressive infiltration lesions, and excluding atelectasis, pulmonary edema, and pleural effusion Age older than 60 years, expected MV >48 h NA Intermittent NA NA
Liu QH, 2006 [36] 86 NA Received MV for >48 h, clinical features and culture of endotracheal aspirate; reduction of oxygen Age older than 60 years, expected MV >48 h 1) expected death within 48 h; 2) expected weaning within 48 h; 3) existing lung infection when MV beginning Continuous NA NA
Lorente, 2007 [38] 280 NA Clinical features and significant quantitative culture via ETT aspiration Expected MV >24 h Age less than 18 years, pregnancy, infection with human immunodeficiency virus, blood leukocyte count less than 1000 cells/mm3, solid or hematological tumor, and/or immunosuppressive therapy Continuous 83.6 % of ETT-PUC-SSD group and 85 % of ETT-C group were receiving antibiotics after cardiothoracic surgery NA
Bouza, 2008 [39] 704 Cardiothoracic ICU Received MV for >48 h, clinical features and culture of endotracheal aspirate; reduction of oxygen Major heart surgery NA Continuous Both group respectively received antibiotics before surgery and every 8 h thereafter for a total of three doses in the ICU Daily defined doses
Yang, 2008 [40] 91 Medical-surgical ICU Clinical features and culture of endotracheal aspirate MV >48 h Intubated before ICU Continuous NA NA
Zheng, 2008 [41] 61 Medical-surgical ICU NA MV >48 h NA Continuous NA NA
Lacherade, 2010 [42] 333 Multicenter, medical-surgical ICU Quantitative culture of protected telescoping catheter sample or bronchoalveolar lavage fluid following clinical suspicion Expected MV >48 h Intubated before ICU; tracheostomy; psychotropic drug overdose; acute drunkenness; cardiac arrest Intermittent Antibiotics therapy was used in 94 % and 92 % of intervention and control groups respectively NA
Seyfi, 2013 [43] 80 ICU of Hazrat Rasool Akram Hospital of Tehran, Iran. NA NA NA Intermittent NA NA
Safdari, 2014 [23] 76 In four ICUs of Educational Hospital in Isfahan, Iran NA Intubated with a conventional endotracheal tube and connected to ventilators for more than 48 h Patients who were admitted to the ICUs with tracheostomy or likely to die in the next 48 h or admitted to these units for treatment of pneumonia or with lung complications like fibrosis or cancer Intermittent performed every 3 h NA NA
Koker, 2014 [24] 51 In a 14-bed ICU NA Requiring prolonged MV for more than 48 h NA Continuous NA NA
Tao, 2014 [22] 149 NA Received MV for >48 h, clinical features and culture of endotracheal aspirate; reduction of oxygen Expected MV >48 h with APACHE score 20–30 Existing lung infection when MV beginning Continuous or intermittent every 4 h NA NA
Damas, 2015 [17] 352 All ICUs of a tertiary hospital Clinical features and culture of endotracheal aspirate Age over 18 years, intubation with a Teleflex Isis™ endotracheal tube (TIET) allowing subglottic secretion suctioning Patient participating in another study or having already participated in this study NA NA The numberof antibiotic days
Gopal, 2015 [21] 240 Cardiothoracic surgery Europe Infection Control through Surveillance definition Age over 70 years and/or left ventricular ejection fraction <50 % and cardiac surgery NA Intermittent every 6 h NA NA
Deem, 2016 [20] 66 All ICUs at Harborview Medical Center Criteria of Center for Disease Control Age over 18 years with intubation and needed critical care 1) Out-of-hospital cardiac arrest; 2) non-study designated intubation devices; 3) airway management other than orotracheal intubation; 4) Federally protected populations, pregnant women, and prisoners Continuous NA NA
  1. APACHE Acute Physiology and Chronic Health Evaluation, ETT-C conventional endotracheal tube, ETT-PUC-SSD endotracheal tube with polyurethane cuff and subglottic secretion drainage, ICU intensive care unit, MV mechanical ventilation, NA not available, SSS subglottic secretion suctioning, VAP ventilator-associated pneumonia
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