Fiberoptic bronchoscopy for the prevention of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials.

IF 1.4 4区医学 Q4 INFECTIOUS DISEASES Journal of Infection in Developing Countries Pub Date : 2024-09-30 DOI:10.3855/jidc.17866

Haowei Tang, Zhi Yuan, Jingjie Li, Qun Wang, Weijie Fan

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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 in patients with invasive MV is effective in reducing the incidence of VAP.

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预防呼吸机相关肺炎的纤维支气管镜检查：随机对照试验荟萃分析。

导言：呼吸机相关性肺炎（VAP）会导致机械通气（MV）时间延长、重症监护室（ICU）住院时间延长以及死亡率升高。本系统综述和荟萃分析旨在比较纤维支气管镜检查（FOB）和普通吸痰对预防侵入性 MV 患者 VAP 的效果：通过搜索 PubMed、Embase、Cochrane Library、万方和 CNKI 数据库，获得相关的随机对照试验（RCT）。如果观察到显著的异质性，则采用随机效应模型对结果进行汇总。否则，采用固定效应模型：结果：共纳入 16 项研究。与普通吸痰相比，使用 FOB 吸痰可显著降低 VAP 风险（风险比 [RR]：0.56，95% CI：0.47 至 0.67，p < 0.001；I2 = 0%）。亚组分析显示，与单独使用 FOB 辅助吸痰法相比，联合使用 FOB 辅助吸痰法和支气管肺泡灌洗（BAL）可进一步降低 VAP 风险（亚组差异 p = 0.04）。此外，FOB 辅助治疗还与 MV 时间缩短（平均差 [MD]: -2.19 天，95% CI: -2.69 to -1.68, p < 0.001; I2 = 18%）、ICU 留观时间缩短（MD: 2.9 天，95% CI：-3.68 至 -2.13，p < 0.001；I2 = 34%），并降低了侵袭性 MV 患者的死亡风险（RR：0.46，95% CI：0.24 至 0.90，p = 0.02；I2 = 0%）：结论：在侵袭性中风患者中使用 FOB 吸痰和 BAL 能有效降低 VAP 的发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection in Developing Countries INFECTIOUS DISEASES-

CiteScore

3.70

自引率

5.30%

发文量

239

审稿时长

4-8 weeks

期刊介绍： The Journal of Infection in Developing Countries (JIDC) is an international journal, intended for the publication of scientific articles from Developing Countries by scientists from Developing Countries. JIDC is an independent, on-line publication with an international editorial board. JIDC is open access with no cost to view or download articles and reasonable cost for publication of research artcles, making JIDC easily availiable to scientists from resource restricted regions.