{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:04:16Z","timestamp":1791475456583,"version":"4.3.4"},"reference-count":51,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T00:00:00Z","timestamp":1675123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008463","name":"Universitas Airlangga","doi-asserted-by":"publisher","award":["811\/UN3.15\/PT\/2022"],"award-info":[{"award-number":["811\/UN3.15\/PT\/2022"]}],"id":[{"id":"10.13039\/501100008463","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Medicina"],"abstract":"<jats:p>Ventilator-associated pneumonia (VAP) is hospital-acquired pneumonia that develops 48 h or longer following mechanical ventilation. However, cuff pressure fluctuates significantly due to patient or tube movement, which might result in microaspiration. Subglottic secretion drainage (SSD) has been suggested as a method for VAP prevention bundles. This systematic review and meta-analysis aims to investigate the efficacy and safety of subglottic SSD in preventing VAP. The secondary outcomes of this study are to investigate the intensive care unit (ICU) stay length and mortality rate regarding VAP. This study followed the Preferred Reporting Item for Systematic Review and Meta-Analysis guidelines. A thorough search of PubMed, Embase, and the Web of Science was conducted between June and August 2022. The study analysis used the Mantel\u2013Haenszel method, and the quality of the included study was assessed using the Cochrane Risk of Bias 2. Eighteen randomized controlled trials with a total of 2537 intubated patients were included. It was found that SSD was associated with a lower risk of VAP (RR 1.44; 95% CI; 1.20\u20131.73; p &lt; 0.0001). The subgroup analysis (utilizing intermittent and continuous methods) found no statistically significant difference between the two groups (p = 0.28). The secondary endpoints showed that there was no significant difference in mortality (RR 1.02; 95% CI; 0.87\u20131.20; p = 0.83), but there were substantial differences in ICU stays (mean difference, 3.42 days; 95% CI; 2.07\u20134.76; p &lt; 0.00001) in favor of the SSD group. This was based on a very low certainty of evidence due to concerns linked to the risk of bias and inconsistency. The use of SSD was associated with a reduction in VAP incidence and ICU stay length, but there was no significant difference in the mortality rate.<\/jats:p>","DOI":"10.3390\/medicina59020283","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T02:52:02Z","timestamp":1675219922000},"page":"283","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["RETRACTED: Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Preventing the Risk of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Control Trials"],"prefix":"10.3390","volume":"59","author":[{"given":"Yulis","family":"Dewi","sequence":"first","affiliation":[{"name":"Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5647-5721","authenticated-orcid":false,"given":"Hidayat","family":"Arifin","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia"},{"name":"School of Nursing, College of Nursing, Taipei Medical University, Taipei 110, Taiwan"},{"name":"Palembang MediRose Publisher, Palembang 30154, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rifky","family":"Pradipta","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arina","family":"Qona\u2019ah","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosita","family":"Rosita","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy","family":"Giatin","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amel","family":"Dawod Kamel Gauda","sequence":"additional","affiliation":[{"name":"Maternal and Newborn Health Nursing, College of Nursing, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of the National Guard, Riyadh 11173, Saudi Arabia"},{"name":"Department of Maternal and Newborn Health Nursing, Faculty of Nursing, Cairo University, Cairo 11562, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1097\/CCM.0000000000005630","article-title":"Effectiveness of continuous cuff pressure control in preventing ventilator-associated pneumonia: A systematic review and meta-analysis of randomized controlled trials","volume":"50","author":"Maertens","year":"2022","journal-title":"Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"103227","DOI":"10.1016\/j.iccn.2022.103227","article-title":"Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies","volume":"70","author":"Blot","year":"2022","journal-title":"Intensive Crit. Care Nurs."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/01.ccm.0000435665.07446.50","article-title":"Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients","volume":"42","author":"Blot","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1007\/s00134-022-06773-3","article-title":"Ventilator-associated pneumonia","volume":"48","author":"Ranzani","year":"2022","journal-title":"Intensive Care Med."},{"key":"ref_5","unstructured":"Jain, V., Vashisht, R., Yilmaz, G., and Bhardwaj, A. (2022). Pneumonia Pathology. StatPearls, StatPearls Publishing LLC."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1186\/s12879-021-06383-2","article-title":"The effect of ventilator-associated pneumonia on the prognosis of intensive care unit patients within 90 days and 180 days","volume":"21","author":"Luo","year":"2021","journal-title":"BMC Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s13613-016-0137-5","article-title":"Impact of ventilator-associated pneumonia on mortality and epidemiological features of patients with secondary peritonitis","volume":"6","author":"Fierro","year":"2016","journal-title":"Ann. Intensive Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1007\/s00540-019-02707-4","article-title":"An endotracheal tube providing \u201cpressurized sealing\u201d prevents fluid leakage in mechanically ventilated critically ill patients: A pilot study","volume":"34","author":"Spapen","year":"2020","journal-title":"J. Anesth."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1097\/TA.0b013e318247cd33","article-title":"Subglottic secretion drainage for preventing ventilator-associated pneumonia: An updated meta-analysis of randomized controlled trials","volume":"72","author":"Wang","year":"2012","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"482","DOI":"10.3389\/fphar.2019.00482","article-title":"Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients","volume":"10","author":"Wu","year":"2019","journal-title":"Front. Pharm."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Teng, G., Wang, N., Nie, X., Zhang, L., and Liu, H. (2022). Analysis of risk factors for early-onset ventilator-associated pneumonia in a neurosurgical intensive care unit. BMC Infect. Dis., 22.","DOI":"10.1186\/s12879-022-07053-7"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.2147\/CIA.S197146","article-title":"Risk factors of ventilator-associated pneumonia in elderly patients receiving mechanical ventilation","volume":"14","author":"Xu","year":"2019","journal-title":"Clin. Interv. Aging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"em420","DOI":"10.29333\/ejgm\/12556","article-title":"Nurses\u2019 knowledge, attitudes, practice, and decision-making skills related to sepsis assessment and management","volume":"19","author":"Rababa","year":"2022","journal-title":"Electron. J. Gen. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Al-Mugheed, K., Bani-Issa, W., Rababa, M., Hayajneh, A.A., Al Syouf, A., Al-Bsheish, M., and Jarrar, M. (2022). Knowledge, practice, compliance, and barriers toward ventilator-associated pneumonia among critical care nurses in eastern mediterranean region: A systematic review. Healthcare, 10.","DOI":"10.3390\/healthcare10101852"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"185","DOI":"10.5152\/cjms.2021.1292","article-title":"Knowledge and Barriers of Critical Care Nurses Regarding Evidence-Based Practices in Ventilator-Associated Pneumonia Prevention","volume":"3","author":"Alkhazali","year":"2021","journal-title":"Cyprus J. Med. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"190107","DOI":"10.1183\/16000617.0107-2019","article-title":"Subglottic secretion drainage for preventing ventilator-associated pneumonia: An overview of systematic reviews and an updated meta-analysis","volume":"29","year":"2020","journal-title":"Eur. Respir. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"105906","DOI":"10.1186\/s13643-021-01626-4","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"10","author":"Page","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.bjid.2017.01.002","article-title":"Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization","volume":"21","author":"Akdogan","year":"2017","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"197","DOI":"10.14715\/cmb\/2022.68.2.28","article-title":"The effect of different solutions in tracheal suctioning on the incidence of pneumonia in patients on the ventilator","volume":"68","author":"Chai","year":"2022","journal-title":"Cell. Mol. Biol."},{"key":"ref_21","first-page":"5193","article-title":"Subglottic secretion drainage and semi-recumbent position for preventing ventilator associated pneumonia","volume":"9","author":"Chen","year":"2016","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1016\/j.ijnurstu.2012.06.003","article-title":"Effect of continuous oral suctioning on the development of ventilator-associated pneumonia: A pilot randomized controlled trial","volume":"49","author":"Chow","year":"2012","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/CCM.0000000000000674","article-title":"Prevention of ventilator-associated pneumonia and ventilator-associated conditions: A randomized controlled trial with subglottic secretion suctioning","volume":"43","author":"Damas","year":"2015","journal-title":"Crit. Care Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1513\/AnnalsATS.201506-346OC","article-title":"Randomized pilot trial of two modified endotracheal tubes to prevent ventilator-associated pneumonia","volume":"13","author":"Deem","year":"2016","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e92\u2013e6","DOI":"10.1093\/ejcts\/ezu483","article-title":"Significant reduction in ventilator-associated pneumonia with the Venner-PneuX System in high-risk patients undergoing cardiac surgery: The Low Ventilator-Associated-Pneumonia study","volume":"47","author":"Gopal","year":"2015","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"261","DOI":"10.4103\/0972-5229.182196","article-title":"Comparison of suction above cuff and standard endotracheal tubes in neurological patients for the incidence of ventilator-associated pneumonia and in-hospital outcome: A randomized controlled pilot study","volume":"20","author":"Ravikumar","year":"2016","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_27","first-page":"461","article-title":"Comparison of prophylactic effects of polyurethane cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes on ventilator-associated pneumonia","volume":"51","author":"Mahmoodpoor","year":"2013","journal-title":"Acta Med. Iran."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.jcrc.2016.11.007","article-title":"A prospective randomized trial of tapered-cuff endotracheal tubes with intermittent subglottic suctioning in preventing ventilator-associated pneumonia in critically ill patients","volume":"38","author":"Mahmoodpoor","year":"2017","journal-title":"J. Crit. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.jcrc.2019.12.024","article-title":"A clinical trial of silver-coated and tapered cuff plus supraglottic suctioning endotracheal tubes in preventing ventilator-associated pneumonia","volume":"56","author":"Mahmoodpoor","year":"2019","journal-title":"J. Crit. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2655","DOI":"10.22207\/JPAM.10.4.23","article-title":"Early replacement of conventional endotracheal tube with endotracheal tube with subglottic suction port for the new intensive care patients; preventive or problematic against ventilator associated events?","volume":"10","author":"Mansoor","year":"2016","journal-title":"J. Pure Appl. Microbiol."},{"key":"ref_31","first-page":"152","article-title":"Effect of intermittent subglottic irrigation with 5% nacl on the prevention of ventilator associated pneumonia in critically ill patients","volume":"18","author":"Naghibi","year":"2019","journal-title":"Tanaffos"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1164\/rccm.201408-1398OC","article-title":"Randomized intubation with polyurethane or conical cuffs to prevent pneumonia in ventilated patients","volume":"191","author":"Philippart","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_33","first-page":"58","article-title":"Effect of Subglottic Secretion Drainage on theVentilator-Associated Pneumonia in ICU Patients","volume":"15","author":"Seyfi","year":"2013","journal-title":"J. Babol Univ. Med. Sci."},{"key":"ref_34","first-page":"283","article-title":"Effect of two methods of subglottic secretion drainage on the incidence of ventilator-associated pneumonia","volume":"37","author":"Tao","year":"2014","journal-title":"Chin. J. Tuberc. Respir. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e11631","DOI":"10.1097\/MD.0000000000011631","article-title":"The benefit of daily sputum suction via bronchoscopy in patients of chronic obstructive pulmonary disease with ventilators: A randomized controlled trial","volume":"97","author":"Qiao","year":"2018","journal-title":"Medicine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.aucc.2019.05.002","article-title":"The interaction of subglottic drainage, cuff pressure, and oral care on endotracheal tube fluid leakage: A benchtop study","volume":"33","author":"Chair","year":"2020","journal-title":"Aust. Crit. Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1097\/CCM.0000000000001414","article-title":"Subglottic Secretion Drainage and Objective Outcomes: A Systematic Review and Meta-Analysis","volume":"44","author":"Caroff","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1186\/s13054-016-1527-7","article-title":"Subglottic secretion suction for preventing ventilator-associated pneumonia: An updated meta-analysis and trial sequential analysis","volume":"20","author":"Mao","year":"2016","journal-title":"Crit. Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1097\/CCM.0b013e318218a4d9","article-title":"Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: A systematic review and meta-analysis","volume":"39","author":"Muscedere","year":"2011","journal-title":"Crit. Care Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1164\/rccm.201412-2316OC","article-title":"Determining the ideal strategy for ventilator-associated pneumonia prevention. Cost\u2013benefit analysis","volume":"192","author":"Wright","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/S1473-3099(13)70081-1","article-title":"Attributable mortality of ventilator-associated pneumonia: A meta-analysis of individual patient data from randomised prevention studies","volume":"13","author":"Melsen","year":"2013","journal-title":"Lancet Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1164\/rccm.201709-1819OC","article-title":"Excess mucin impairs subglottic epithelial host defense in mechanically ventilated patients","volume":"198","author":"Powell","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"16","DOI":"10.55048\/jpns.v1i1.3","article-title":"The Implementation of Inspiratory Muscle Training to Enhance Weaning from Mechanical Ventilation: A Systematic Literature Review","volume":"1","author":"Priambodo","year":"2022","journal-title":"J. Plb. Nurs. Stud."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"25","DOI":"10.55048\/jpns.v1i1.2","article-title":"Nurses Barrier: A Patient Safety Concern in The Intensive Care Unit","volume":"1","author":"Gunawan","year":"2022","journal-title":"J. Plb. Nurs. Stud."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1186\/s13054-021-03588-4","article-title":"Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: A planned ancillary analysis of the coVAPid cohort","volume":"25","author":"Nseir","year":"2021","journal-title":"Crit. Care"},{"key":"ref_46","first-page":"4826933","article-title":"Incidence and Risk Factors of Ventilator-Associated Pneumonia among Patients with Delirium in the Intensive Care Unit: A Prospective Observational Study","volume":"2022","author":"Shamsizadeh","year":"2022","journal-title":"Crit. Care Res. Pract."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s13054-021-03484-x","article-title":"The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: An observational study","volume":"25","author":"He","year":"2021","journal-title":"Crit. Care"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1017\/ice.2022.88","article-title":"Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update","volume":"43","author":"Klompas","year":"2022","journal-title":"Infect. Control. Hosp. Epidemiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.iccn.2013.02.007","article-title":"Intermittent subglottic secretion drainage may cause tracheal damage in patients with few oropharyngeal secretions","volume":"29","author":"Suys","year":"2013","journal-title":"Intensive Crit. Care Nurs."},{"key":"ref_50","first-page":"27","article-title":"The association of subglottic secretion drainage and tracheal mucosa injury","volume":"6","author":"Yiating","year":"2020","journal-title":"Eur. Respir. Soc."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/s13613-017-0291-4","article-title":"Systemic antibiotics for preventing ventilator-associated pneumonia in comatose patients: A systematic review and meta-analysis","volume":"7","author":"Righy","year":"2017","journal-title":"Ann. 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