title: Silver-coated endotracheal tube versus non-coated endotracheal tube for preventing ventilator-associated pneumonia among adults: a systematic review of randomized controlled trials.
abstract: OBJECTIVE
  To compare the effects of using silver-coated endotracheal tube (ETT) versus non-coated ETT on the incidence of ventilator-associated pneumonia (VAP) and mortality in adult patients.
  
  
  METHODS
  We searched MEDLINE, the Cochrane Library, EMBASE, and the Chinese Biomedical Literature Database from inception to June 30, 2011. We also retrieved the reference lists of included studies and reviews. Randomized controlled trials (RCTs) comparing silver-coated ETTs versus non-coated ETTs were included. We pooled the results using a random-effect model and conducted subgroup analyses and sensitivity analyses to address the heterogeneity between studies.
  
  
  RESULTS
  We identified two eligible RCTs with a total of 1630 participants. The studies were of high quality according to Cochrane Collaboration's tool for assessing risk of bias. Compared with non-coated ETTs, silver-coated ETTs resulted in lower incidence of VAP (RR=0.64, 95% CI 0.43 to 0.96), device-related adverse events (RR=0.53, 95% CI 0.32 to 0.88), and microbiologic burden (≥10,000 CFU/mL: 0.64, 0.48 to 0.86; ≥100,000 CFU/mL: 0.62, 0.43 to 0.89). However, there was no significant difference in total mortality (RR=1.14, 95% CI 0.99 to 1.30).
  
  
  CONCLUSIONS
  The limited evidence from meta-analysis of two RCTs showed that using silver-coated ETTs reduced the incidence of VAP, microbiologic burden, and device-related adverse events among adult patients. Additional rigorous randomized trials are needed to confirm these findings.
authors.affiliation: Chinese Cochrane Centre/ Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
authors.forename: Qiang
authors.initials: Q
authors.lastname: Yuan
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Liang
authors.initials: L
authors.lastname: Du
authors.forename: Lijing
authors.initials: L
authors.lastname: Deng
mesh_terms: D000328:Adult; D020099:Coated Materials, Biocompatible; D003428:Cross Infection / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000009:adverse effects*; D018030:Silver Compounds
chemical_list: D020099:Coated Materials, Biocompatible; D018030:Silver Compounds