title: Internally coated endotracheal tubes with silver sulfadiazine in polyurethane to prevent bacterial colonization: a clinical trial.
abstract: OBJECTIVE
  Coated medical devices have been shown to reduce catheter-related infections. We coated endotracheal tubes (ETT) with silver sulfadiazine (SSD), and tested them in a clinical study to assess the feasibility, safety, and efficacy of preventing bacterial colonization.
  
  
  METHODS
  A prospective, randomized clinical trial, phase I-II.
  
  
  METHODS
  Academic intensive care unit (ICU).
  
  
  METHODS
  Forty-six adult patients expected to need 12-24 h of intubation were randomized into two groups.
  
  
  METHODS
  Patients were randomized to be intubated with a standard non-coated ETT (St-ETT, n=23; control group), or with a SSD-coated ETT (SSD-ETT, n=23).
  
  
  RESULTS
  Coating with SSD prevented bacterial colonization of the ETT (frequency of colonization: SSD-ETT 0/23, St-ETT 8/23; p<0.01). No organized bacterial biofilm could be identified on the lumen of any ETT; however, SSD was associated with a thinner mucus layer (in the SSD-ETT secretion deposits ranged from 0 to 200 microm; in the St-ETT deposits ranged between 50 and 700 microm). No difference was observed between the two groups in the tracheobronchial brush samples (frequency of colonization: SSD-ETT 0/23, St-ETT 2/23; p=0.48). No adverse reactions were observed with the implementation of the novel device.
  
  
  CONCLUSIONS
  SSD-ETT can be safely used in preventing bacterial colonization and narrowing of the ETT in patients intubated for up to 24 h (mean intubation time 16 h).
authors.affiliation: Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. lberra@partners.org
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Berra
authors.forename: Theodor
authors.initials: T
authors.lastname: Kolobow
authors.forename: Patrice
authors.initials: P
authors.lastname: Laquerriere
authors.forename: Betsey
authors.initials: B
authors.lastname: Pitts
authors.forename: Simone
authors.initials: S
authors.lastname: Bramati
authors.forename: Joshua
authors.initials: J
authors.lastname: Pohlmann
authors.forename: Chiara
authors.initials: C
authors.lastname: Marelli
authors.forename: Miriam
authors.initials: M
authors.lastname: Panzeri
authors.forename: Pietro
authors.initials: P
authors.lastname: Brambillasca
authors.forename: Federico
authors.initials: F
authors.lastname: Villa
authors.forename: Andrea
authors.initials: A
authors.lastname: Baccarelli
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bouthors
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
authors.forename: Luca M
authors.initials: LM
authors.lastname: Bigatello
authors.forename: Joel
authors.initials: J
authors.lastname: Moss
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
mesh_terms: D000368:Aged; D020099:Coated Materials, Biocompatible; D015169:Colony Count, Microbial; D004202:Disinfectants / Q000008:administration & dosage / Q000494:pharmacology*; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D018613:Microscopy, Confocal; D008855:Microscopy, Electron, Scanning; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D011140:Polyurethanes / Q000494:pharmacology; D011446:Prospective Studies; D012837:Silver Sulfadiazine / Q000008:administration & dosage / Q000494:pharmacology*; D018709:Statistics, Nonparametric; D012122:Ventilators, Mechanical / Q000009:adverse effects / Q000382:microbiology*
chemical_list: D020099:Coated Materials, Biocompatible; D004202:Disinfectants; D011140:Polyurethanes; D012837:Silver Sulfadiazine