Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial.
BACKGROUND
Ventilator-associated pneumonia (VAP) causes substantial morbidity. A silver-coated endotracheal tube has been designed to reduce VAP incidence by preventing bacterial colonization and biofilm formation.


OBJECTIVE
To determine whether a silver-coated endotracheal tube would reduce the incidence of microbiologically confirmed VAP.


METHODS
Prospective, randomized, single-blind, controlled study conducted in 54 centers in North America. A total of 9417 adult patients (> or = 18 years) were screened between 2002 and 2006. A total of 2003 patients expected to require mechanical ventilation for 24 hours or longer were randomized.


METHODS
Patients were assigned to undergo intubation with 1 of 2 high-volume, low-pressure endotracheal tubes, similar except for a silver coating on the experimental tube.


METHODS
Primary outcome was VAP incidence based on quantitative bronchoalveolar lavage fluid culture with 10(4) colony-forming units/mL or greater in patients intubated for 24 hours or longer. Other outcomes were VAP incidence in all intubated patients, time to VAP onset, length of intubation and duration of intensive care unit and hospital stay, mortality, and adverse events.


RESULTS
Among patients intubated for 24 hours or longer, rates of microbiologically confirmed VAP were 4.8% (37/766 patients; 95% confidence interval [CI], 3.4%-6.6%) in the group receiving the silver-coated tube and 7.5% (56/743; 95% CI, 5.7%-9.7%) (P = .03) in the group receiving the uncoated tube (all intubated patients, 3.8% [37/968; 95% CI, 2.7%-5.2%] and 5.8% [56/964; 95% CI, 4.4%-7.5%] [P = .04]), with a relative risk reduction of 35.9% (95% CI, 3.6%-69.0%; all intubated patients, 34.2% [95% CI, 1.2%-67.9%]). The silver-coated endotracheal tube was associated with delayed occurrence of VAP (P = .005). No statistically significant between-group differences were observed in durations of intubation, intensive care unit stay, and hospital stay; mortality; and frequency and severity of adverse events.


CONCLUSIONS
Patients receiving a silver-coated endotracheal tube had a statistically significant reduction in the incidence of VAP and delayed time to VAP occurrence compared with those receiving a similar, uncoated tube.


BACKGROUND
clinicaltrials.gov Identifier: NCT00148642.
Kollef
Marin H
MH
Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA. mkollef@im.wustl.edu
Afessa
Bekele
B
Anzueto
Antonio
A
Veremakis
Christopher
C
Kerr
Kim M
KM
Margolis
Benjamin D
BD
Craven
Donald E
DE
Roberts
Pamela R
PR
Arroliga
Alejandro C
AC
Hubmayr
Rolf D
RD
Restrepo
Marcos I
MI
Auger
William R
WR
Schinner
Regina
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local; D018441:Biofilms; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation; D012307:Risk Factors; D018030:Silver Compounds; D016037:Single-Blind Method; D013997:Time Factors
D000891:Anti-Infective Agents, Local; D018030:Silver Compounds