Search

Background. Microaspiration of secretions around the tracheal cuff is a multifactorial process. Tracheal cuff shape might take a major part in its occurrence. The rationale for producing a taper-shaped cuff is established on the assumption that compared to a conventional cuff with a single fixed diameter, a continuum of minimum-to-maximum diameter sections might better fit the tracheal walls. Objectives. The primary objective of this meta-analysis was to compare ventilator-associated pneumonia (VAP) between tapered-cuff intubation and conventional-cuff intubation. The secondary objective was to compare intensive care unit (ICU) mortality between tapered-cuff intubation and conventional-cuff intubation. Methods. We searched the Cochrane Library, Embase, MEDLINE database through the PubMed search engine, and CINAHL from inception to April 2018. Randomized trials comparing VAP and ICU mortality between tapered-cuff intubation and conventional-cuff intubation in intubated adults were included. Two review authors assessed study quality and abstracted databasing on prespecified criteria independently. Results. We pooled summary estimates from 5 trials evaluating tapered-cuff involving 774 participants. Compared to VAP, no statistically significant difference was observed between the tapered-cuff and conventional-cuff groups (OR 0.82, CI 0.61–1.12, z = 1.24, and p=0.21). No statistically significant difference was observed between the tapered-cuff and conventional-cuff groups with ICU mortality (OR 0.77, CI 0.55–1.08, z = 1.49, and p=0.14). Conclusions. In this meta-analysis, the tapered-cuff tracheal tube may not be superior to the standard-cuff tracheal tube in reducing VAP and ICU mortality.

As there are conflicting reports regarding the association between obstructive sleep apnoea (OSA) and cancer incidence and mortality, a meta-analysis was performed to evaluate whether OSA is independently associated with cancer incidence and mortality. Pubmed, EMBASE and Web of Science were searched up until November 2014. Studies that assessed OSA and the future risk of cancer incidence or mortality were included. Pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) were calculated. Subgroup analysis was conducted based on the polysomnographic variable, apnoea-hypopnoea index. Six studies, which involved 114 105 participants, were pooled in this meta-analysis. Fixed-effects analysis showed the pooled adjusted HR of cancer incidence as 0.91 (95% CI, 0.74-1.13; P = 0.408) for mild OSA, 1.07 (95% CI, 0.86-1.33; P = 0.552) for moderate OSA and 1.03 (95% CI, 0.85-1.26; P = 0.743) for severe OSA. Random-effects analysis demonstrated neither mild OSA (adjusted HR, 0.79; 95% CI, 0.46-1.34; P = 0.381), moderate OSA (adjusted HR, 1.92; 95% CI, 0.63-5.88; P = 0.251) nor severe OSA (adjusted HR, 2.09; 95% CI, 0.45-9.81; P = 0.349) correlated with cancer mortality. This meta-analysis indicates that OSA is not independently associated with cancer incidence and mortality according to currently available data. Additional experimental and human research is required to determine the exact association between OSA and cancer.