Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
JAMA. 2008 Aug 20;300(7):805-13. doi: 10.1001/jama.300.7.805.

Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial.

Collaborators (141)

Afessa B, Hubmayr R, Wilson G, Ansari T, Manchester T, Anzueto A, Restrepo MI, Bakhta S, Fiedler D, Kucera S, Houlihan T, Arroliga AC, Isabella T, Komara J, Ferrari M, Carney D, Blosser S, Novchich T, Collin G, Bernstein B, Coppa G, Temperino M, Craven DE, DiGregorio S, Lamb C, Polcaro J, Criner G, Grabianowski C, Dellinger P, Stillwell C, DeMarini T, Maslanka N, Allen B, Douglas I, Lathrop D, Freilich E, Amin D, Woods LM, Phillips T, Freire A, Thompson S, Umberger R, Friedman B, Redman D, Wilson J, Gallagher JT, Wishin J, Lavon AJ, Caruso L, Gabrielli A, Bennett N, Ginzburg E, Derr B, Hata SJ, Shelsky C, Herr D, Bolouri N, Hyzy R, Cooperson D, Johnson JE, Waldrum MR, Wille K, O'Hare L, Kaplan C, Dettenmeire P, Katragadda S, Steinhauser T, Kaufman D, Harvey T, Keene A, Moltz K, Koppisetti S, Liz M, Kerr K, Auger W, Munden B, Gabel L, Kindt G, Funke LM, Athmann L, Kirtland S, Zeller J, Klapholz A, Hardinge L, Klausner H, Defoe LA, Kollef M, Doyle A, Lange N, Giambartolomei S, Thoutt G, Lawlor DP, Schroeder ML, Leeper K, Weyers C, Manasia A, Delguidice R, Mapel D, Ponder R, Margolis B, Doornbos C, Martin C, Morrow L, Galkowski M, Niederman M, Jacobs P, Pastores S, Alicea M, Schneider L, Phillips C, Bacon K, Roberts P, Bennett J, Rodricks M, Mattix C, Rodriguez W, Yapor PJ, Ayala G, Scheinberg P, Bensen C, Sanders R, Schelbar EJ, Boomer WM, Goulet JK, Sluss J, Simpson S, Conyers K, Summer W, Romaine C, Sy A, McFarland E, Thompson AB, Scheetz M, Veremakis C, O'Brien J, Willms D, Middlebrook S, Wood KA, Abraham A, Carlins JH, Griffin-Glatz V.

Author information

  • 1Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA. mkollef@im.wustl.edu

Abstract

CONTEXT:

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.

DESIGN, SETTING, AND PARTICIPANTS:

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.

INTERVENTION:

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.

MAIN OUTCOME MEASURES:

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.

CONCLUSION:

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.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT00148642.

Comment in

PMID:
18714060
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems
    Loading ...
    Write to the Help Desk