title: Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial.
abstract: 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.
authors: Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA. mkollef@im.wustl.edu
authors: Marin H
authors: MH
authors: Kollef
authors: Bekele
authors: B
authors: Afessa
authors: Antonio
authors: A
authors: Anzueto
authors: Christopher
authors: C
authors: Veremakis
authors: Kim M
authors: KM
authors: Kerr
authors: Benjamin D
authors: BD
authors: Margolis
authors: Donald E
authors: DE
authors: Craven
authors: Pamela R
authors: PR
authors: Roberts
authors: Alejandro C
authors: AC
authors: Arroliga
authors: Rolf D
authors: RD
authors: Hubmayr
authors: Marcos I
authors: MI
authors: Restrepo
authors: William R
authors: WR
authors: Auger
authors: Regina
authors: R
authors: Schinner
mesh_terms: 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
chemical_list: D000891:Anti-Infective Agents, Local; D018030:Silver Compounds