Pneumonia prevention to decrease mortality in intensive care unit. A systematic review and meta-analysis.
Clin Infect Dis. 2014 Sep 24;
Authors: Roquilly A, Marret E, Abraham E, Asehnoune K
BACKGROUND: The objective was to determine the strategies of prevention of hospital acquired pneumonia (HAP) that reduce mortality in intensive care unit (ICU).
METHODS: Preferred Reported Items for Systemic Reviews and Meta-Analysis guidelines were followed. We searched the MEDLINE and COCHRANE controlled trials register (through June, 10(th) 2014) as well as reference lists of articles. We included all randomized controlled trials conducted in critically ill adult patients hospitalized in ICU and evaluating digestive prophylactic methods (selective digestive decontamination (SDD), acidification of gastric content, early enteral feeding, prevention of micro-inhalation); circuit prophylactic methods (closed suctioning systems, early tracheotomy, aerosolised antibiotics, humidification, lung secretion drainage, silver coated endotracheal tubes) or oro-pharyngeal prophylactic methods (selective oropharyngeal decontamination, patient position, sinusitis prophylaxis, subglottic secretion drainage, tracheal cuff monitoring). One reviewer extracted data that were checked by 3 others. The primary outcome was the mortality rate in ICU.
RESULTS: We identified 157 randomized trials to pool in a meta-analysis. The primary outcome was available in 145 studies (n=37156). The risk ratio (RR) for death was 0.95 (95% confidence interval (CI), 0.92-0.99; p=0.02) in the intervention groups. In sub-group analysis, only SDD significantly decreased mortality as compared to control (n=10227; RR, 0.84; 95%CI, 0.76-0.92; p=0.0003). The RR for in-ICU death was 0.78 (CI95%, 0.69-0.89; p=0.0001, I(2)=33%) in trials investigating SDD with systemic antimicrobial therapy and 1.00 (CI95%, 0.84-1.21; p=0.96; I(2)=0%) without systemic antimicrobial therapy.
CONCLUSIONS: SDD with systemic antimicrobial therapy reduced mortality and should be considered in critically ill patients at high risk for death.
PMID: 25252684 [PubMed - as supplied by publisher]