Efficacy and safety of airway clearance techniques in Chinese adult patients with pneumonia: a systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to synthesize the available evidence from Chinese randomized controlled trials to evaluate the efficacy and safety of airway clearance techniques compared to conventional treatment in adult patients with pneumonia, including stroke-associated pneumonia, severe viral pneumonia, and severe pneumonia requiring mechanical ventilation. METHODS: We systematically searched PubMed, Web of Science, Cochrane Library, CNKI, and Wanfang databases from inception to January 1, 2026, for randomized controlled trials (RCTs) comparing airway clearance techniques plus conventional treatment vs. conventional treatment alone. Two reviewers independently conducted study selection, data extraction, and quality assessment. Data were pooled using a random-effects model in Stata, with between-study heterogeneity evaluated. RESULTS: Eleven randomized controlled trials were included. Meta-analysis showed airway clearance techniques significantly increased treatment effectiveness (OR 3.83, 95% CI 2.04-7.16; I2 = 0%) and reduced complications (OR 0.16, 95% CI 0.07-0.41; I2 = 0%). They also improved arterial oxygen saturation (SMD 1.71, 95% CI 1.24-2.19), albeit with considerable heterogeneity (I2 = 76.2%). No significant effect was found on the mMRC Dyspnea Score (SMD-3.64, 95% CI -7.45-0.18), with very high heterogeneity (I2 = 98.1%). CONCLUSION: In conclusion, this meta-analysis provides hypothesis-generating evidence that airway clearance techniques may improve treatment effectiveness, reduce complications, and enhance oxygenation in Chinese adult patients with pneumonia. However, due to heterogeneity, methodological limitations, and lack of long-term patient-centered outcomes, these findings require confirmation in future international multicenter trials.