Airway tracers and biomarkers for aspiration detection and ventilator-associated pneumonia (VAP) prediction in ICU patients with tracheal tubes: a systematic review and diagnostic accuracy meta-analysis
Authors' conclusion
Current airway tracers and biomarkers do not appear suitable as standalone diagnostic triggers for VAP. However, airway α-amylase may have potential as a negative-predictive screening tool.
Study context
- Population
- Critically ill adults receiving invasive mechanical ventilation or with artificial airways (ICU)16 studies
- Outcome
- Upstream microleakage or aspiration-related event detection and downstream VAP prediction (dual endpoint)
Methodological detailsbivariate random-effects pooling, QUADAS-2 risk of bias
- Bivariate random-effects pooling
- QUADAS-2 risk of bias
Pooled result
As reported in the abstract
VAP prediction
| Group | Pooled sensitivity | Specificity | AUC |
|---|---|---|---|
| Airway α-amylase | 78.1% | 70.3% | 0.811 |
Airway α-amylase
Pooled sensitivity78.1%
Specificity70.3%
AUC0.811
Further pooled results
Aspiration detection by blue-dye visual methods
- Summarized descriptively, not pooled; FEES-validated tracheostomy studies reported relatively high sensitivity for swallowing-related transglottic aspiration
- Enteral-tracer or reflux-aspiration monitoring studies limited by surrogate reference standards and/or low visual detectability for continuous, low-volume microleakage
Original publication
Airway tracers and biomarkers for aspiration detection and VAP prediction in ICU patients with tracheal tubes: a systematic review and diagnostic accuracy meta-analysis. Ann Intensive Care. Published 28 July 2026. doi:10.
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