• Xiaoyu Zhang, Xuanxuan Cui, Mengke Jiang, Shanshan Huang, and Min Yang.
• The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui, Hefei 230601, China; Laboratory of Cardiopulmonary Resuscitation and Critical Care, the Second Affiliated Hospital of Anhui Medical University, Anhui, Hefei 230601, China; Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Anhui, Hefei 230601, China.
• J Crit Care. 2023 Oct 1; 77: 154315154315.

PurposeNebulized colistin (NC) is a potential therapy for ventilator-associated pneumonia (VAP); however, the clinical efficacy and safety of NC remain unclear. This study investigated whether NC is an effective therapy for patients with VAP.Materials And MethodsWe performed a search in Web of Science, PubMed, Embase, and the Cochrane Library to retrieve randomized controlled trials (RCTs) and observational studies published at any time until February 6, 2023. The primary outcome was clinical response. Secondary outcomes included microbiological eradication, overall mortality, length of mechanical ventilation (MV), length of intensive care unit stay (ICU-LOS), nephrotoxicity, neurotoxicity, and bronchospasm.ResultsSeven observational studies and three RCTs were included. Despite exhibiting a higher microbiological eradication rate (OR,2.21; 95%CI, 1.25-3.92) and the same nephrotoxicity risk (OR,0.86; 95%CI, 0.60-1.23), NC was not significantly different in clinical response (OR,1.39; 95%CI, 0.87-2.20), overall mortality (OR,0.74; 95%CI, 0.50-1.12), MV length (mean difference (MD),-2.5; 95%CI, -5.20-0.19), and the ICU-LOS (MD,-1.91; 95%CI, -6.66-2.84) than by the intravenous antibiotic. Besides, the risk of bronchospasm raised significantly (OR, 5.19; 95%CI, 1.05-25.52) among NC.ConclusionNC was associated with better microbiological outcomes but did not result in any remarkable changes in the prognosis of patients with VAP.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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