JAMA. 2008 Aug 20;300(7):805-13.
Kollef MH, Afessa B, Anzueto A, Veremakis C, Kerr KM, Margolis BD, Craven DE,
Roberts PR, Arroliga AC, Hubmayr RD, Restrepo MI, Auger WR, Schinner R; NASCENT
Investigation Group.
Collaborators: 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.
Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110,
USA. mkollef@im.wustl.edu
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.