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

JAMA : the Journal of the American Medical Association
Marin H KollefNASCENT Investigation Group

Abstract

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. To determine whether a silver-coated endotracheal tube would reduce the incidence of microbiologically confirmed VAP. 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. 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. 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. Among patients intubated for 24 hours or longer, rates of microbiologically confirmed VAP were 4...Continue Reading

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