Tapered Cuff versus Conventional Cuff for Ventilator-Associated Pneumonia in Ventilated Patients: A Meta-Analysis of Randomized Controlled Trials

Table 1

Characteristics of the five randomized controlled trials included in the meta-analysis.

Author, year	Design	Country	Kind of ICU	No. of patients	Endotracheal tube type	Internal diameter of tracheal tube	Cuff pressure	PEEP	VAP assessment	Duration of follow-up	Quality assessment
Jaillette et al. 2017 [14]	Multicenter, randomized, cross-over, open-label	France	Mixed ICU	Tapered (), standard ().	PVC tapered-cuffs (TaperGuard; Covidien, Athlone, Ireland); PVC standard cuffs (Hi-Lo; Covidien, Athlone, Ireland)	7.5 and 8 mm	Tapered 29 (26–30) cmH2O, conventional 28 (25–30)cmH2O	>5 cmH2O	Using clinical, radiographic, and microbiological criteria.	Until 28 days or ICU discharge	Good
Mahmoodpoor et al., 2013, [16]	Randomized, single-blind	Iran	Mixed ICU	Tapered (), standard ().	TaperGuard tubes (PU, cone-/taper-shaped cuffs with subglottic suction ports); SealGuard tubes (PU, cylindrical-/barrel-shaped cuffs with subglottic secretion suction ports).	Male 8.0 to 8.5 mm, female 7.0 to 7.5 mm.	Tapered (24.07 ± 0.48 cmH2O), conventional (24.10 ± 0.49 cmH2O)	5 cmH2O	VAP was defined based on clinical, radiological, and laboratory findings based on CPIS.	Until ICU discharge	Good
Mahmoodpoor et al., 2017, [15]	Randomized, single-blind	Iran	Surgical ICU	Tapered (), conventional ().	TaperGuard tubes; conventional high-volume low-pressure endotracheal tubes.	Male 8.0 to 8.5 mm, female 7.0 to 7.5 mm.	Tapered (23.7 ± 2.3 cmH2O), conventional (27.0 ± 4.7 cmH2O)	5 cmH2O	Suspected by clinical infection pulmonary score (CPIS)	Until ICU discharge	Good
Monsel et al., 2016, [17]	Randomized, single-blind	France	Surgical ICU	Tapered (), standard ().	TaperGuard (Covidien, Ireland); standard cuffs with high contour Brandt endotracheal tubes incorporating a polyvinyl chloride spherical-shaped cuff (Mallinckrodt Medical,USA)	The endotracheal tube size was chosen according to professional guidelines.	25 cmH2O	Tapered 5.6 (5.0–6.3) cmH2O, conventional 5.0 (5.0–6.0) cmH2O	VAP was confirmed when Johanson criteria were associated with a significant concentration of bacteria isolated from lower respiratory tract.	Lengths of mechanical ventilation and ICU stay.	Good
Philippart et al., 2015, [13]	Randomized, multicenter, open-lablel	France and Tunisia	Medical surgical ICUs	Tapered (), standard ()	TaperGuard (Covidien, Ireland); cylindrical (Hi-Lo; Covidien, Dublin, Ireland)	The patients received tracheal intubation with a 7.5–8.0 mm diameter.	The cuff was inflated to a pressure of 25–30 cmH2O	≥5 cmH2O	VAP was confirmed when the quantitative culture was at least 10^4 cfu/ml in a bronchoalveolar lavage or 10^5 dfu/ml in a quantitative tracheal aspirate.	Until ICU discharge	Good