 |
|
Silver-Coated Endotracheal Tubes and Incidence of Ventilator-Associated PneumoniaThe NASCENT Randomized Trial
Marin H. Kollef, MD;
Bekele Afessa, MD;
Antonio Anzueto, MD;
Christopher Veremakis, MD;
Kim M. Kerr, MD;
Benjamin D. Margolis, MD;
Donald E. Craven, MD;
Pamela R. Roberts, MD;
Alejandro C. Arroliga, MD;
Rolf D. Hubmayr, MD;
Marcos I. Restrepo, MD;
William R. Auger, MD;
Regina Schinner, Dipl-Stat; for the NASCENT Investigation Group
JAMA. 2008;300(7):805-813.
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 ( 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 104 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
Author Affiliations: Washington University School of Medicine, St Louis, Missouri (Dr Kollef); Mayo Clinic College of Medicine, Rochester, Minnesota (Drs Afessa and Hubmayr); South Texas Veterans Health Care System Audie L. Murphy Division, San Antonio, Texas (Drs Anzueto and Restrepo); University Hospital and University of Texas Health Science Center at San Antonio (Dr Anzueto); St John's Mercy Medical Center, St Louis, Missouri (Dr Veremakis); University of California at San Diego, La Jolla (Drs Kerr and Auger); West Suburban Hospital, Oak Park, Illinois (Dr Margolis); Lahey Clinic Medical Center, Burlington, Massachusetts, and Tufts University School of Medicine, Boston, Massachusetts (Dr Craven); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Roberts); Cleveland Clinic, Cleveland, Ohio (Dr Arroliga); VERDICT, San Antonio, Texas (Dr Restrepo); and FGK Clinical Research GmbH, Munich, Germany (Ms Schinner). Dr Roberts is now with the University of Oklahoma Health Sciences Center, Oklahoma City. Dr Arroliga is now with Scott & White Health Care System and Texas A & M Health Science Center College of Medicine, Temple, Texas.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED LETTER
Silver-Coated Endotracheal Tubes and Patient Outcomes in Ventilator-Associated Pneumonia
Michael Klompas
JAMA. 2008;300(22):2605.
EXTRACT
| FULL TEXT
RELATED ARTICLE
Preventing Ventilator-Associated Pneumonia: Could Silver-Coated Endotracheal Tubes Be the Answer?
Jean Chastre
JAMA. 2008;300(7):842-844.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Late-Onset Ventilator-Associated Pneumonia in Nontrauma Intensive Care Unit Patients
Gacouin et al.
Anesth. Analg. 2009;109:1584-1590.
ABSTRACT
| FULL TEXT
Carriage Classification of Pneumonia Rather Than Time Improves Survival
Silvestri et al.
Chest 2009;136:1188-1189.
FULL TEXT
A Randomized Trial of Dental Brushing for Preventing Ventilator-Associated Pneumonia
Pobo et al.
Chest 2009;136:433-439.
ABSTRACT
| FULL TEXT
Implementation of a Real-time Compliance Dashboard to Help Reduce SICU Ventilator-Associated Pneumonia With the Ventilator Bundle
Zaydfudim et al.
Arch Surg 2009;144:656-662.
ABSTRACT
| FULL TEXT
Update in Critical Care 2008
Fowler et al.
Am. J. Respir. Crit. Care Med. 2009;179:743-758.
FULL TEXT
Oral Decontamination to Prevent Ventilator-Associated Pneumonia: Is It a Sound Strategy?
Dallas and Kollef
Chest 2009;135:1116-1118.
FULL TEXT
VAT vs VAP: Are We Heading Toward Clarity or Confusion?
Dallas and Kollef
Chest 2009;135:252-255.
FULL TEXT
Silver-Coated Endotracheal Tubes and Patient Outcomes in Ventilator-Associated Pneumonia
Klompas
JAMA 2008;300:2605-2605.
FULL TEXT
Prophylaxis of Ventilator-Associated Pneumonia: Changing Culture and Strategies to Trump Disease
Craven and Hjalmarson
Chest 2008;134:898-900.
FULL TEXT
Do Silver-Coated Endotracheal Tubes Decrease the Incidence of Ventilator-Associated Pneumonia?
Kolovos
AAP Grand Rounds 2008;20:56-57.
FULL TEXT
All you need to read in the other general journals
BMJ 2008;337:a1423-a1423.
FULL TEXT
Preventing Ventilator-Associated Pneumonia: Could Silver-Coated Endotracheal Tubes Be the Answer?
Chastre
JAMA 2008;300:842-844.
FULL TEXT
Can Silver-Coated Endotracheal Tubes Reduce VAP Incidence?
JWatch Infect. Diseases 2008;2008:2-2.
FULL TEXT
|
