Objective  To systematically evaluate the effects of vibration sputum expulsion and artificial sputum expulsion on preventing ventilator-associated pneumonia (VAP) in patients with severe traumatic brain injury (sTBI).

Methods  The relevant literature in PubMed, the Cochrane Library, Embase, Web of Science, CBM, CNKI, VIP and WanFang database were searched from inception to March 2024. Related studies on preventing VAP in patients with sTBI using vibration and artificial sputum expulsion were collected. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias for included study. RevMan 5.4 software was used for Meta-analysis.

Results  A total of 8 studies were included, including 7 randomized controlled trials and 1 non-randomized controlled trial, with 967 study subjects. The Meta-analysis results showed that compared with artificial sputum expulsion, vibration sputum expulsion could reduce the incidence of VAP [RR=0.49, 95%CI(0.37, 0.64), P<0.001], delay the occurrence of VAP [MD=1.47, 95%CI(1.34, 1.59), P<0.001], shorten hospitalization time [MD=-6.02, 95%CI(-9.76, -2.28), P=0.002] and mechanical ventilation time [MD=-4.89, 95%CI(-8.64, -1.13), P=0.01], and improve the effective rate of sputum expulsion [RR=1.18, 95%CI(1.08, 1.28), P<0.001]. There was no statistically significant difference in mortality rate between the two sputum evacuation methods in sTBI patients.

Conclusion Compared to artificial sputum expulsion, vibration sputum expulsion has a better effect on preventing VAP in sTBI patients, promoting effective sputum removal and accelerating recovery. However, due to the quality of the included studies, high-quality randomized controlled trials are still needed for further validation in the future.

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