Is continuous better than intermittent control of tracheal cuff pressure? A meta-analysis.

AIM: To compare and evaluate the efficacy and safety of continuous and intermittent control of Pcuff .

METHODS: We performed a comprehensive and systematic meta-analysis of randomized controlled trials (RCTs) assessing the continuous and intermittent control of Pcuff by searching PUBMED, EMBASE and other such databases (from inception to 31 March 2018). Summary odds ratios or mean differences with 95% confidence intervals were calculated using a fixed- or random-effects model.

MEASUREMENTS AND MAIN RESULTS: Seven RCTs with 970 MV patients were included in this study. The continuous control of Pcuff significantly reduced the incidence of Pcuff < 20 cm H2 O (0.03 (95% CI: 0.01-0.07)), Pcuff > 30 cm H2 O (0.06 (95% CI: 0.03-0.15)) and VAP (0.39 (95% CI: 0.28-0.55)) when compared with intermittent control of Pcuff . No significant differences in duration of MV (-1.94 (95% CI: -4.06 to -0.17)), length of ICU stay (-3.88 (95% CI: -9.00 to -1.23)) and mortality (0.99 (95% CI: 0.73-1.35)) were found between the two groups.

CONCLUSIONS: Continuous control of Pcuff offers more benefits in stabilizing the Pcuff and reducing the incidence of VAP, and more studies are warranted to further evaluate the role of continuous control of Pcuff .

RELEVANCE TO PRACTICE: The continuous control of Pcuff should be conducted whenever possible as it is the most ideal for the prognosis of MV patients.